Heart failure: Basic Cocepts
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Heart failure occurs when the heart is unable to pump enough blood to meet the body's needs. It can develop when the heart muscle is damaged, such as from a myocardial infarction. There are two main types - left heart failure which causes blood to back up in the lungs, and right heart failure where blood backs up in the body. Symptoms depend on whether it is left or right heart failure, and include shortness of breath, fatigue, swelling, and coughing. Treatment focuses on reducing cardiac workload, increasing blood oxygen levels, and limiting fluid buildup through medications, oxygen therapy, and monitoring for arrhythmias.
Heart failure: Basic Cocepts
- 1. Heart Failure Dr Arindam Pande, MBBS (Hons), MD, DM, FESC, FACC (USA) Consultant Cardiologist, Academic Coordinator: DNB Cardiology and PGDCC Training Apollo Gleneagles Hospital, Kolkata
- 2. www.healthprice.in Heart Heart has four chambers - Two Atrium(upper) Two Ventricles(lower)
- 3. www.healthprice.in Atria – It collects blood from the body. Ventricle- It supplies blood to the body Right Ventricle supplies blood to lungs Left Ventricle supplies blood into the system for circulation
- 5. • In medical terms heart failure is defined as the condition when heart is unable to pump enough blood required for normal body functions. • Human body needs sufficient amount of oxygen which is supplied by heart through blood. Heart failure is a serious condition and needs immediate medical care. What is Heart Failure?
- 6. Congestive Heart Failure Congestion of pulmonary or systemic circulation (backward failure) Reduced output to body tissues (forward failure)
- 7. 7 Cardiac structural abnormalities occur as a result of injury and remodeling MI=myocardial infarction Konstam et al. J Am Coll Cardiol 2011;4:98–108 Cardiac injury (e.g. MI) Infarct zone thinning and elongation Spherical ventricular dilation Fibrous scar Myocyte hypertrophy Increased Interstitial collagen Ventricle
- 8. LV=left ventricular McMurray. N Engl J Med 2010;362:228–38; Francis et al. Ann Intern Med 1984;101:370–7; Krum, Abraham. Lancet 2009;373:941–55 The pathophysiology of chronic HF HF symptoms dyspnea, edema, fatigue Progressive remodelling and worsening of LV function Morbidity and mortality arrhythmias, pump failure Hemodynamic alterations, salt and water retention These changes lead to systemic neurohormonal imbalance Damage to cardiac myocytes and extracellular matrix leads to changes in the size, shape and function of the heart (remodeling) and cardiac wall stress This may lead to fibrosis, apoptosis, hypertension, hypertrophy, cellular and molecular alterations, myotoxicity
- 9. Congestive Heart Failure Left sided Right sided Biventricular
- 10. Left-Sided Heart Failure • Left ventricle fails as effective pump • Left ventricle cannot eject blood delivered from right heart through pulmonary circulation • Blood backs up into pulmonary circulation
- 11. Left-Sided Heart Failure • Increase pressure in pulmonary capillaries forces blood serum out of capillaries into interstitial spaces and alveoli • Increase respiratory work and decrease gas exchange occur
- 12. Left-Sided Heart Failure • Common causes • ACUTE MI • especially if involves left ventricle • Chronic hypertension • Dysrhythmias • especially tachydysrhythmias
- 14. Left Heart Failure Symptoms • Dyspnea on exertion • Paroxysmal nocturnal dyspnea • Orthopnea • Fatigue, generalized weakness
- 15. Left Heart Failure Signs • Anxiety, confusion, restlessness • Persistent cough • Pink, frothy sputum • Tachycardia • Tachypnea • Noisy, labored breathing • Rales, wheezing (“cardiac asthma”) • Cyanosis (late) • Third heart sound (S3)
- 16. Right-sided Heart Failure • Right ventricle fails as effective pump • Right ventricle cannot eject blood returning through vena cavae • Blood backs up into systemic circulation
- 17. Right Heart Failure • Increased pressure in systemic capillaries forces fluid out of capillaries into interstitial spaces • Tissue edema occurs
- 18. Right Heart Failure Causes Most Common Cause: Left sided Heart Failure
- 19. Right Heart Failure Causes • Others • Chronic pulmonary hypertension (Idiopathic) • COPD (cor pulmonale) • Congenital Heart Disease • Pulmonary embolism • Right ventricular infarction
- 21. Right Heart Failure Signs/Symptoms • Tachycardia • Jugular vein distension • Pedal, pre-tibial, sacral edema • Hepatomegaly • Splenomegaly Classic Triad of Right Ventricular Failure: JVD, Hypotension, Clear Lungs
- 22. Right Heart Failure Signs/Symptoms • Anasarca (generalized edema) • Fluid accumulation in body cavities • Ascites • Pleural effusion • Pericardial effusion
- 23. Management of Heart Failure
- 24. Goals of Management • Improve oxygenation, ventilation • Decrease venous return to heart • Decrease cardiac work, O2 demand • Improve cardiac output by • Reducing afterload • Increasing myocardial contractility
- 25. Management • Sit patient up, dangle feet • Do not lay flat • Oxygen by non-rebreather mask • Consider positive pressure ventilation
- 26. Management • Consider intubation if: • O2 saturation cannot be kept >90% on 100% O2 • PaO2 cannot be kept >60 torr on 100 % O2 • Patient displays signs of worsening cerebral hypoxia • PaCO2 progressively increases • Patient becoming exhausted
- 27. Management • Monitor ECG • Hypoxia, increased heart wall tension leads to dysrhythmias • IV NS TKO via microdrip or lock • Limit Fluids • If RVF only, fluid challenges to preload
- 28. Drug management in acute setings • Nitroglycerin • Furosemide (Lasix®) - • Morphine Sulfate • Dobutamine, Noradrenaline • Bronchodilators (beta agonists) • Digitalis
- 29. Long Term CHF Management • Fluid minimization • Diuretics (+ Potassium if non-potassium sparing) • Diet restrictions • Increase contractility • Digitalis • Blood pressure control • ACE Inhibitors • Betablockers • ARNI • Ivabradin • Coronary artery perfusion • Nitroglycerin
- 30. If medication or other means fail to improve the condition, left ventricular assist devices and / or heart transplantation is opted. For patients in cardiogenic shock, ECMO (extracorporeal membrane oxygenator) therapy is given to stabilize the condition temporarily.
- 31. THANKS 31