heart Failure

HEART FAILURE

Definition Heart Failure is a complex clinical syndromethat can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood.

Heart Failure TypesLeft Heart Failure:

- Involves the left ventricle (lower chamber) of the heart

- Systolic failure

The heart looses its ability to contract or pump blood into the circulation

- Diastolic failure

The heart looses its ability to relax because it becomes stiff

Heart cannot fill properly between each beat

Contd..Left Heart Failure:Systolic and diastolic heart failure are treated with different types of medicationsIn both types, blood may back up in the lungs causing fluid to leak into the lungs (pulmonary edema)Fluid may also build up in tissues throughout the body (edema)

Right Heart Failure:Usually occurs as a result of left heart failureThe right ventricle pumps blood to the lungs for oxygenOccasionally isolated right heart failure can occur due to lung disease or blood clots to the lung (pulmonary embolism)

Causes:Health conditions that either damage the heart or make it work too hardCoronary artery diseaseHeart attackHigh blood pressureAbnormal heart valvesHeart muscle diseases (cardiomyopathy)Heart inflammation (myocarditis)

Causes contd..Congenital heart defectsSevere lung diseaseDiabetesSevere anemia HyperthyroidismAbnormal heart rhythms

Causes contd:Heart attackAn artery supplying blood to the heart becomes blockedLoss of oxygen and nutrients damages heart muscle tissue causing it to dieRemaining healthy heart muscle must pump harder to keep up

Causes contd:High blood pressureUncontrolled high blood pressure doubles a persons risk of developing heart failureHeart must pump harder to keep blood circulatingOver time, chamber first thickens, then gets larger and weaker

Causes contd:Abnormal heart valvesHeart muscle diseaseDamage to heart muscle due to drugs, alcohol or infectionsCongenital heart diseaseSevere lung disease

Causes Contd:DiabetesTend to have other conditions that make the heart work harderObesityHypertensionHigh cholesterol

Causes contd: Severe anemiaNot enough red blood cells to carry oxygenHeart beats faster and can become overtaxed with the effort Hyperthyroidism Body metabolism is increased and overworks the heart Abnormal Heart Rhythm If the heart beats too fast, too slow or irregular it may not be able to pump enough blood to the body

RISK FACTORS:Myocardial ischemia or infractDietary sodium excessExcess fluid intakeMedication noncomplianceArrhythmiasInfectionConditions associated with increased metabolic demand (eg pregnancy, thyrotoxicosis, excessive physical activity)Administration of drug (eg. NSAIDs, corticosteroids)AlcoholSmoking

Signs and Symptoms Shortness of Breath (dyspnea)WHY? Blood backs up in the pulmonary veins because the heart cant keep up with the supply an fluid leaks into the lungsSYMPTOMSDyspnea on exertion or at restDifficulty breathing when lying flatWaking up short of breath

Signs and Symptoms contd..Persistent Cough or WheezingWHY? Fluid backs up in the lungsSYMPTOMSCoughing that produces white or pink blood-tinged sputum

Signs and Symptoms contd..EdemaWHY? Decreased blood flow out of the weak heartBlood returning to the heart from the veins backs up causing fluid to build up in tissuesSYMPTOMSSwelling in feet, ankles, legs or abdomenWeight gain

Signs and Symptoms contd..Tiredness, fatigueWHY? Heart cant pump enough blood to meet needs of bodies tissuesBody diverts blood away from less vital organs (muscles in limbs) and sends it to the heart and brainSYMPTOMSConstant tired feelingDifficulty with everyday activities

Signs and Symptoms contd..Lack of appetite/ NauseaWHY? The digestive system receives less blood causing problems with digestionSYMPTOMSFeeling of being full or sick to your stomach

Signs and Symptoms contd..Confusion/ Impaired thinkingWHY? Changing levels of substances in the blood ( sodium) can cause confusionSYMPTOMSMemory loss or feeling of disorientationRelative or caregiver may notice this first

Signs and Symptoms contd..Increased heart rateWHY? The heart beats faster to make up for the loss in pumping functionSYMPTOMSHeart palpitationsMay feel like the heart is racing or throbbing

MANAGEMENT:To improve symptoms and quality of lifeTo decrease likelihood of disease progressionTo reduce the risk of death and need for hospitalisation

Treatment Options:The more common forms of heart failure cannot be cured, but can be treatedLifestyle changesMedicationsSurgery

LIFE STYLE CHANGES:Stop smokingLoose weightAvoid alcoholAvoid or limit caffeineEat a low-fat, low-sodium dietExercise

Lifestyle changesReduce stressKeep track of symptoms and weight and report any changes or concern to the doctorLimit fluid intakeSee the doctor more frequently

Recommended Therapies:Drug therapy for all patientsDiuretics for fluid retentionACEIBeta-blockersDrug therapy for selected patientsAldosterone AntagonistsDigitalisExercise Testing and Training

HF Therapy(Reduced LVEF with Symptoms)

Medications used to treat Heart FailureVasodilatorsCause blood vessel walls to relaxOccasionally used if patient cannot tolerate ACEDecrease workload of the heart

Medications used to treat Heart FailureACE InhibitorsCornerstone of heart failure therapyProven to slow the progression of heart failureVasodilator cause blood vessels to expand lowering blood pressure and the hearts work load

ACE Inhibitors: physiologic benefits Arteriovenous Vasodilatation pulmonary arterial diastolic pressure left ventricular end-diastolic pressure systemic vascular resistance systemic blood pressure maximal oxygen uptake (MVO2)

ACE Inhibitors: physiologic benefits LV function and cardiac output renal, coronary, cerebral blood flowNo change in heart rate or myocardial contractilityno neurohormonal activation

Guidelines to ACE Inhibitor TherapyContraindicationsRenal artery stenosisRenal insufficiency (relative)HyperkalemiaArterial hypotensionCoughAngioedema

Medications Diuretics:Prescribed for fluid build up, swelling or edemaCause kidneys to remove more sodium and water from the bloodstreamDecreases workload of the heart and edemaFine balance removing too much fluid can strain kidneys or cause low blood pressure

DiureticsIndicated in patients with symptoms of heart failure who have evidence of fluid retentionEnhance response to other drugs in heart failure such as beta-blockers and ACE inhibitors

Medications:Digitalis preparationsIncreases the force of the hearts contractionsRelieves symptomsSlows heart rate and certain irregular heart beats

Medications:Beta-blockersLower the heart rate and blood pressureDecrease the workload of the heartBLOOD THINNERS (COUDIMINE)Used in patients at risk for developing blood clots in the blood vessels, legs, lung and heartUsed in irregular heart rhythms due to risk of stroke

Treatment options:Surgery and other Medical ProceduresNot often used in heart failure unless there is a correctable problemCoronary artery bypassAngioplastyValve replacementDefibrillator implantationHeart transplantationLeft ventricular assist device (LVAD)

Surgical TherapyRevascularizationValve repair, replacementVentricular remodelingCardiomyoplasty

Surgical TherapyIntra-aortic balloon pump (IABP)Ventricular assist device (VAD)Temporary therapyDestination therapyHeart transplantTotal artificial heart