HEART FAILURE

HEART FAILURE

1. Definition

   • Is a clinical syndrome that occurs in patients who, because of an inherited or acquired abnormality of cardiac structure or function, resulting in heart cannot pump enough blood to meet the body's needs

2. Epidemiology

   • The overall prevalence of HF in the adult population in developed countries is 2%
   • Rise with age, and affects 6–10% of people over age 65

3. Etiology

   • Depressed Ejection Fraction
     • Coronary artery disease, Hypertension, Nonischemic dilated cardiomyopathy
   • Preserved Ejection Fraction
     • Pathologic hypertrophy, Restrictive cardiomyopathy
   • Pulmonary Heart Disease
   • High-Output States

4. Pathophysiology

   • The heart may not supply the tissues with adequate blood to meet their metabolic needs
   • The primary abnormality may be a disorder of cardiomyocyte function
   • Heart failure with reduced ejection fraction
     • systolic heart failure
   • Heart failure with preserved ejection fraction
     • diastolic heart failure

5. Clinical manifestations

   • The cardinal symptoms of HF are fatigue and shortness of breath
   • Orthopnea
     • Dyspnea occurring in the recumbent position
   • Paroxysmal Nocturnal Dyspnea
     • Is an acute episode of severe shortness of breath and coughing that generally occurs at night and awakens the patient from sleep
   • Cheyne-Stokes respiration
     • Cheyne-Stokes respiration is caused by an increased sensitivity of the respiratory center to arterial PCO2 and a lengthy circulatory time

6. Diagnosis

   • Routine laboratory testing
     • Patients with new-onset HF and those with chronic HF and acute decompensation should have a complete blood count, a panel of electrolytes
   • Electrocardiogram
     • The major importance is to assess cardiac rhythm and determine the presence of LV hypertrophy or a prior MI
   • Chest X-ray
     • Provides useful information about cardiac size and shape, as well as the state of the pulmonary vasculature
   • Biomarkers
     • Circulating levels of natriuretic peptides are useful adjunctive tools in the diagnosis of patients with HF

7. Treatment

   • The objectives of HF treatment are: To improve clinical status, functional capacity and quality of life, prevent hospitalizations and reduce mortality
   • ACE inhibitors
     • They have shown a reduction in mortality and morbidity in patients with HF
   • Beta blockers
     • They reduce mortality and morbidity in HF patients with reduced LVEF
   • Mineralocorticoids
     • Spironolactone and Eplerenone are recommended in all symptomatic patients
   • Diuretics
     • Recommended to reduce congestive signs and symptoms