heart failure

1. Heart failure
By- kajal sansoya

2. Normal heart

3. Introduction
• Heart failure is defined as a state in which the
ventricles at normal filling pressures cannot
maintain an adequate cardiac output to meet
the metabolic needs of peripheral tissue or
can do so only with an elevated filling
pressure.

4. • Heart failure is a chronic condition in which
heart does not pump well as it was supposed
to be.
• It results from any structural or functional
impairment of ventricles filling or ejection of
blood.

5. INCIDENCE
• More than 20 million people have heart failure
worldwide.
• Prevalence of heart failure in India due to CHD,
hypertension, RHD ,obesity to range from 1.3 to
4.6 million, with an annual incidence of
491600-1.8 million.
• Heart failure is leading cause of hospitalization
in people older than 65.

6. Pathology
• Preload – refers to pressure that fills the left
ventricles during diastole.
• After-load- refers to pressure against which
the left ventricle contracts.
• Myocardial contractility- this mainly depends
upon the adrenergic nervous activity and the
levels of circulating catecholamines.

7. • In heart failure there is an increase in preload
, increase in after load, decrease myocardial
contractility.
• cardiac output(CO)= stroke volume(SV)x heart rate(HR)
• SV determined by preload , after load, myocardial
contractility.

8. Types of heart failure
1. Acute or chronic
2. Low output or high output
3. Left side or right sided or biventricular
4. Forward or backward
5. Systolic or diastolic

9. Acute heart failure
• develops suddenly
• Sudden reduction in CO which results in
systemic hypotension.
• Example- acute MI,
rupture of valve,
block blood flow to heart muscle.

10. Chronic heart failure
• develops gradually , aortic pressure is
maintained but edema accmulate.
• Example – dilated cardiomyopathy
multivalvular disease

11. Low output heart failure
• Associated with a low CO.
• Heart fails to generate adequate output or can
do so with high filling pressure.
• Example – IHD, pericardial disease,
cardiomyopathy

12. High output heart failure
• Heart fails to maintain sufficient circulation
despite an increase CO.
• Example – hyperthyroidsm, anemia,
pregnancy, paget’s disease.

13. Left-sided heart failure
• Reduction or decrease ventricular output
• Increase in left atrial pressure
• Increase pulmonary venous pressure
• Example – MI , aortic stenosis

14. Right-sided heart failure
• Excess fluid accumulates upstream behind the
failing right ventricle.
• There is reduction in right ventricular output
and increase in right atrial & systemic venous
pressure.
• Decrease right ventricle output results in
systemic venous congestion.
• Example – pulmonary valvular stenosis,
multiple pulmonary emboli.

15. Biventricular heart failure
• Failure of both right and right side ventricles.
• Example – IHD, dilated cardiomyopathy.

16. • Forward heart failure - Decrease in CO and
inadequate perfusion of organs leading to
poor tissue perfusion.
• Backward heart failure- normal CO, but
marked salt, water retention, pulmonary &
systemic venous congestion.

17. • Systolic heart failure- abnormal ventricular
contraction
• Diastolic heart failure- impaired ventricular
relaxation and increase ventricular stiffness
results in diastolic dysfunction.

19. Risk factors
• Hypertension
• Diabetes mellitus
• Thyroid
• CAD
• Hyperlipidaemia

20. Etiology
• Pressure overload of ventricles
aortic stenosis , pulmonary stenosis, pulmonary
hypertension.
• Volume overload of ventricles
aortic regurgitation, ASD, PDA, mitral
regurgitation.
• Inflow obstruction of ventricle
mitral stenosis, tricuspid stenosis,
endomyocardial fibrosis.

21. • Impaired ventricular function
diffuse myocardial disease, myocarditis, IHD,
cardiomyopathy , segmental myocardial
disease.

22. Aggravating factors
• Myocardial infarction
• Intercurrent illness
• Arrhythmia
• Pulmonary embolism
• Systemic hypertension
• Condition associated with increase metabolic
demand ( pregnancy, anemia)

23. Clinical features
• Dyspnoea
• Orthopnoea
• Paronysmal noctural dyspnoea
• Cardiac asthma
• Cheyne-stokes ( periodic breathing)
• Nocturia (frequent urination at night)
• Cerebral symptoms( confusion, headache,
insomia)
• Acute pulmonary edema

24. Non-specific features
• Nausea
• fatigue
• Anorexia
• Cardiac cachexia
• Jugular venous pressure increase
• Oliguria
• Pleural effusion, ascities , pericardial effusion
• liver (hepatomegaly, enlarged liver, jaundice)

26. Complications
• Renal heart failure
• Hyopkalaemia
• Hyperkalaemia
• Imparied liver function
• Hyonatraemia
• Thromboembolism
• Atrial and ventricular arrhytmias

27. Diagnosis
• Cardiomegaly
• CT, X-ray shows promience of upper lobe
veins, increase bronchovascular markings,
pleural effusion.
• ECG- hypertrophy, arrhythmias, active
ischemia, MI
• Renal and liver test – FLP, LFT

28. X-ray findings of heart failure

29. ECG in heart failure

30. Management
• Life style changes
• Physical & emotional rest
• Diet changes
• Medical management
• Surgery

31. Medical management
• NSAIDS
• ACE inhibitors
• Beta-blockers
• Diuretics
• Vasodilators
• Digoxin
• Sympathominetics amines
• Dopamine used in acute heart failure

32. Management of heart failure
Removal of precipitating
or aggravating cause
Correction of
underlying cause
Treatment of HF
Reduced cardiac
remodelling
•Ace inhibitors
Reduction of cardiac
stress
•Vasodilators
•Beta-blockers
Increase myocardial
contractility
•digoxin
•Sympathomimetic
amines
control of salt&
water retention
•Diuretics
• decrease sodium
intake

33. Thank you