Heart Failure

Heart Failure
Heart Failure:
• A clinical syndrome in which either structural or functional abnormalities
• The heart pumps insufficient oxygenated blood to meet the metabolic needs of the tissues
• An elevated filling pressure.
? Left-sided (pulmonary edema)
? Right-sided ( hepatomegaly & systemic edema)
? both sides of the heart
? Exercise intolerance and fatigue are common
? A progressive disorder + M&M.

A No structural HD & no sym. but risk factors: CAD, HTN, DM, cardio toxins, familial cardiomyopathy Lifestyle , exercise, smoking; hyperlipidemia & ACEI for HTN
B Abnormal LV systolic F, MI, valvular HD but no HF sym. Lifestyle , ACEI, BB
C Structural HD & HF sym. Lifestyle, ACEI, BB, Diuretics, Digoxin
D Refractory HF sym. to maximal medical management Therapy listed under A, B, C & mechanical assist device, heart transplant., continuous IV inotropic infusion, hospice care in selected patients



I (mild) No sym. while performing ordinary physical activity (walking, climbing stairs, etc.)
II (mild) Mild sym.(mild shortness of breath, palpitations, fatigue, and/or angina) and slight limitation during ordinary physical activity
III (moderate) Marked limitation in activity due to sym., even during less-than-ordinary activity (walking short distances [20–100 m]). Comfortable only at rest
IV (severe) Severe(sym. even while at rest)

Compensatory adaptations :
? Activation of (RAAS) & vasopressin (AD hormone), which lead to
? Increased Na retention and peripheral vasoconstriction.
? Sympathetic nervous system is activated
? Increased levels of circulating catecholamines
? Increased myocardial contractility.
? Direct cellular toxicity, fibrosis, arrhythmias, and pump failure.
? The reduction in cardiac output results in organ hypoperfusion, and pulmonary and systemic venous congestion.
Etiology
? CAD is the most frequent cause
? Valvular heart disease
? Toxins induced (alcohol, cocaine, chemotherapy)
? Myocarditis (infectious or autoimmune)
? Familial cardiomyopathy
? Infiltrative disease (amyloidosis, sarcoidosis, hemochromatosis)
? Peripartum cardiomyopathy