congestive heart failure

overview

definitions and epidemiology

pathophysiologys

prognosis

therapeutic opyions

diastolic heart failure

Heart failure epidemiology :2014

More death from heart failure than all cancers

2000 : 5 milion symptomatic patients

2 milions pts have asymptomatic LV dysfunction

2037 : estimated 10 milion symptomatic patients

43,000 deaths annually directly attributable to HF

220,000 deaths with HF as contributing factor

550,000 new cases yearly

prevalence > 10% above age 80

Increasing incidence and prevalence due to aging population and better care of hypertension and CAD

ACC/AHA Stages of Heart Failure : Stages A and B

Stage A

- Patients at high risk of developing heart failure as a result of the presence of conditions that strongly
assosiated with thr development of hearth failure. These pasient do not have any identified structural or
functional abnormalities of the pericardium, myocardium, or cardiac valves and have never shown signs
or symptoms of heart failure.

Stage B

-Patients who have developed structural heart disease that is strongly assosisated with development of
heart failure but who have never shown sign or symptoms of heart failure.

Stage C

-Patients who have current or prior symptoms of heart failure assosiated with underlying structural heart
disease.

Stage D

- Patients who have advanced structural heart disease and marked symptoms of heart failure at rest
despite maximal medical therapy and who require specialized interventions.

Major causes of heart failure

Myocardial ischemia /infarction

complication of myocardial infarction

acute valvular regurgitation

severe uncontrolled hypertension

myocarditis

sustained arrhytmias

decompensation of chronic CHF

Acute pulmonary embolism

Trends in CHF epidemiology

 Coronary artery disease (CAD) an increasing factor

 Systolic dysfuctions in 60-70%, but diastolic dysfunction in almost half of elderly patients

 Sign and symptoms of congestion (rales, dyspnea) are not always evident in patient with
heart failure.
  Arrhytmias are common

- Nonsustained VT in approximately 50%

- Complex VPD in approximately 80 %

 40% to 50% of death are sudden and may occur unexpectedly despite apparent clinical
compensation.

HF Pathogenesis and Therapy :Historical perspective

Hemodynamic model

- Preload

- Afterload

- Contractility

 Neurohormonal

 Remodeling

Long term postmyocardial infarction outcome : Heart Failure

 inability of the heart to provide cardiac output sufficient to meet tissue demand at
normal ventricular filling pressures.

GAMBAR RONTGENT THORAXREMODELING

Compensatory Mechanism in Heart Failure

 As ventricular function deteriorates, the heart relies on variety of adaptive mechanism

to help maintain adequate cardiac output:

- Frank - Starling law of the heart

 - Renin-angiotensin- aldosterone system

- Sympathetic nervous system

Gambar frank sterling law

Gambar Neurohormonal activation in heart failure

Management of Heart Failure

Assess acuity

establish diagnosis

define syndrome(systolic vs dyastolic) and etiology

correct precipitating factors

- evaluate and correct ischemia

Treatment goals

-improve symptoms

-reverse pathophysiology

-improve outcomes

CHF Presipitating Factor

Ischemia

Infarction

Infection (including endocarditis)

Arrhythmia

Embolism (pulmonary)

Anemia
Endocrine (Thyroid, adrenal glands)
Inflammation (myocarditis)

Indiscretion (medications, diet)

Alogaritm Outcome after MI

table therapy HF