Heart Failure

Heart failure clinical classifications, symptoms, clinical examination findings, investigations and management in short.

1. Heart Failure Dima Lotfie 13901022

2. Heart failure is the pathophysiological state in which the heart fails to provide sufficient cardiac output to satisfy the metabolic needs of the body. Main causes include: 1- Coronary artery disease 2- Hypertension 3- Valvular heart disease 4- Cardiomyopathy 5- Cor Pulmonale

3. Clinical classification According to the course of disease: - Acute HF Chronic HF According to location : Left side heart failure Right side heart failure Biventricular heart failure According to function impaired: Systolic failure Diastolic failure

4. Systolic Diastolic More prominent in men More prominent in women Any age, typically 50-70 years Elderly Depressed left ventricular EF (40% or lower) Preserved or normal left ventricular EF (40% or higher) Usually from coronary disease Due to LVH and chronic replacement by fibrous tissue. Then/weak heart wall Thick/stiff heart wall Systolic heart failure (pumping problem): inability of the heart to contract enough to provide blood flow forwards Diastolic heart failure (filling problem): inability of the left ventricle to relax normally, resulting in fluid backing up into the lungs. Systolic vs. diastolic

5. Symptoms: FACES F: fatigue A: activities limitation C: chest congestion E: edema S: shortness of breath

6. On examination: Systolic Diastolic JVP distention Normal JVP Peripheral edema Hypertension S3 S4 Crackles Crackles

7. The Framingham criteria for the diagnosis of heart failure consists of the concurrent presence of either 2 major criteria or 1 major and 2 minor criteria. Major criteria include the following: - Paroxysmal nocturnal dyspnea - Weight loss of 4.5 kg in 5 days in response to treatment Neck vein distention - Acute pulmonary edema - Hepatojugular reflux - S 3 gallop - Central venous pressure greater than 16 cm water - Circulation time of 25 seconds - Radiographic cardiomegaly - Pulmonary edema, visceral congestion, or cardiomegaly at autopsy.

8. Minor criteria are as follows: - dry cough - Dyspnea on ordinary exertion - A decrease in vital capacity by one third the maximal value recorded - Pleural effusion - Tachycardia (rate of 120 bpm) - Bilateral ankle edema

9. Investigations Complete blood count (CBC) Urinalysis Electrolyte levels Renal and liver function studies Fasting blood glucose levels Lipid profile Thyroid stimulating hormone (TSH) levels B-type natriuretic peptide levels N-terminal pro-B-type natriuretic peptide Electrocardiography Chest radiography

10. ECG Systolic heart failure: LBBB grade III Old MI Diastolic heart failure: - Left ventricular hypertrophy