Dr SAMIR TAYFOUR CONSULTANT CARDIOLOGIST HAIL CARIAC CENTRE KSA
Jul 10, 2015
Dr SAMIR TAYFOURCONSULTANT CARDIOLOGIST
HAIL CARIAC CENTREKSA
normal Pump failure
Causes of left ventricular failure
• Volume over load: Regurgitate valve
High output status
• Pressure overload: Systemic hypertension
Outflow obstruction
• Loss of muscles: Post MI, Chronic ischemia
Connective tissue diseases
Infection, Poisons (alcohol,cobalt,Doxorubicin)
• Restricted Filling: Pericardial diseases, Restrictive
cardiomyopathy, tachyarrhythmia
Forward Vs Backward Rt. Vs Lt. sided HF Biventricular HF Acute Vs Chronic HF Flash pulmonary edema Low Vs High output HF Systolic Vs Diastolic HF
Ventricular RemodelingVentricular remodeling after acute infarction
Ventricular remodeling in diastolic and systolic heart failure
Initial infarct Expansion of infarct(hours to days)
Global remodeling(days to months)
Normal heart Hypertrophied heart(diastolic heart failure)
Dilated heart(systolic heart failure)
Framingham Criteria for Congestive Heart FailureMajor criteria:
Paroxysmal nocturnal dyspnea Neck vein distention Rales Radiographic cardiomegaly Acute pulmonary edema S3 gallop Increased central venous pressure (>16 cm H2O at right atrium) Hepatojugular reflux Weight loss >4.5 kg in 5 days in response to treatment
Minor criteria: Bilateral ankle edema Nocturnal cough Dyspnea on ordinary exertion Hepatomegaly Pleural effusion Decrease in vital capacity by one third from maximum recorded Tachycardia (heart rate>120 beats/min.)
Class INo limitations of physical activityClass IISlight limitations of physical activityClass IIIMarked limitations of physical activityClass IVInability to carry out physical activities without discomfort and/or symptoms at rest
Class II1.68 M(35%)
Class IV240 K(5%)
Class III1.20 M(25%)
Class I1.68 M(35%)
AHA Heart and Stroke Statistical Update 2001
Stages of Heart Failure
At Risk for Heart Failure:
STAGE A High risk for developing HF
STAGE B Asymptomatic LV dysfunction
Heart Failure:
STAGE C Past or current symptoms of HF
STAGE D End-stage HF
Stages of Heart Failure
• Designed to emphasize preventability of HF
• Designed to recognize the progressive nature of LV dysfunction
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ACC/AHA HF stages1
•High risk for developing HF •No structural disease
•Structural heart disease•No HF symptoms
•Structural heart disease•Prior or current HF symptoms
•Refractory end-stage HFrequiring special interventions
1Hunt SA et al. J Am Coll Cardiol. 2001;38:2101–2113. 2Criteria Committee of the New Year Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 7th ed. Boston: Little, Brown, 1973:286.
A
B
C
D
NYHA functional classes2
Asymptomatic
Symptomatic with moderate exertion
Symptomatic with minimal exertion
Symptomatic at rest
Class I
Class II
Class IV
Class III
The Progressive Development of The Progressive Development of Cardiovascular DiseaseCardiovascular Disease
Endstage Heart DiseaseEndstage Heart Disease
Congestive Heart FailureCongestive Heart Failure
Ventricular DilationVentricular Dilation
RemodelingRemodeling
Arrhythmia & Loss of MuscleArrhythmia & Loss of Muscle
Myocardial InfarctionMyocardial Infarction
Myocardial IschemiaMyocardial Ischemia
CADCAD
AtherosclerosisAtherosclerosis
Endothelial DysfunctionEndothelial Dysfunction
Risk FactorsRisk Factors
Coronary ThrombosisCoronary Thrombosis
>65years>65years Leading cause of hospitalizationLeading cause of hospitalization
Number 1 KillerNumber 1 Killer
55 years from diagnosis years from diagnosis
only only 50%50% alive alive
Evolving paradigms of heart failure progression.
De Keulenaer G W , and Brutsaert D L Circulation 2011;123:1996-2005
Copyright © American Heart Association
Conceptual approaches to cardiac performance.
De Keulenaer G W , and Brutsaert D L Circulation 2011;123:1996-2005
Copyright © American Heart Association
The heart failure spectrum.
De Keulenaer G W , and Brutsaert D L Circulation 2011;123:1996-2005
Copyright © American Heart Association
The ventricle is a dissipative structure with emerging properties.
De Keulenaer G W , and Brutsaert D L Circulation 2011;123:1996-2005
Copyright © American Heart Association
Volume – overload
hypertrophy
Normal heart
Pressure – overload
Hypertrophy
BNP With chronic heart failure, atrial mycotes secrete increase
amounts of atrial natriuretic peptide (ANP) and brain natriuretic pepetide (BNP) in response to high atrial and ventricular filling pressures
Usually is > 400 pg/mL in patients with dyspnea due to heart failure.
•B-type BNP is secreted by the ventricles in response to
increase in ventricular pressure or volume stress
•The diagnostic accuracy of BNP increases tremendously with inclusion of patients with
HFPEF
• BNP has reported sensitivity of 91% and specificity of 82%
• BNP is developing into an exclusion test for heart failure
however role of BNP for defining prognosis and monitoring of therapy still requires more
investigation