Heart

Failure

By

Mahmoud Abdelbadie 
Lecturer of Cardiovascular 
Medicine
Mansoura University 
Heart Failure
 Results from any structural or
functional abnormality that impairs
the ability of the ventricle to eject
blood (Systolic Heart Failure) or
to fill with blood (Diastolic Heart
Failure).
 Causes

 Coronary Artery Disease

 Idiopathic dilated cardiomyopathy (DCM)
 Mycoarditis (viral)
 Hypertension
 Valvular Heart Disease
 Hypertrophic obstructive cardiomyopathy
(HCM)
 Restrictive cardiomyopathy
Clinical Presentation of Heart Failure

 Dyspnea (most sensitive symptom)

 Orthopnea
 Paroxysmal Nocturnal Dyspnea (PND)
 Edema lower limb
 GIT congestion:
 Anorexia Nausea and vomiting
 Hepatic congestion and Ascites
Classification of Heart Failure

 New York Heart Association (NYHA)

 Class I – symptoms of HF only at
levels that would limit normal
individuals.
 Class II – symptoms of HF with
ordinary exertion
 Class III – symptoms of HF on less
than ordinary exertion
 Class IV – symptoms of HF at rest
 Physical Examination in Heart Failure

 Crackles or decreased breath sounds at

bases on lung exam
 Cardiomegaly

 Elevated jugular venous pressure

 Ascites, Hepatomegaly and Splenomegaly
 Lower extremity edema
 Cool, pale, cyanotic extremities
Lab Analysis in Heart Failure
 CBC
 Since anemia can exacerbate heart failure

 Serum electrolytes and creatinine

 before starting high dose diuretics

 Fasting Blood glucose

 To evaluate for possible diabetes mellitus

 Viral studies
 If viral mycocarditis suspected
 Laboratory Analysis (cont.)
 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.

 Chest X-ray in Heart Failure
 Cardiomegaly
 Pulmonary congestion : Cephalization of
the pulmonary vessels
 Pleural effusions
Cardiomegaly
Pulmonary vessel congestion
 Cardiac Testing in Heart Failure

 Electrocardiogram:
 May show specific cause of heart
failure:
 Ischemic heart disease

 Echocardiogram:
 Left ventricular ejection fraction
 valvular disease
Further testing in Heart Failure
 Endomyocardial biopsy
 Not frequently used
 Really only useful in cases such as viral-

induced cardiomyopathy
Treatment of Heart Failure

 Correction of systemic factors

 Thyroid dysfunction
 Infections
 Uncontrolled diabetes
 Hypertension
 Lifestyle modification
 Lower salt intake
 Alcohol cessation
 Medication compliance
Order of Therapy

1. Loop diuretics / Potassium sparing

diuretcs
2. ACE inhibitor (or ARB if not
tolerated)
3. Beta blockers
4. Digoxin
5. Hydralazine, Nitrate
 Chronic HF-End Stage HF

 Nonpharmacologic therapies
 Intraaortic balloon pump (IABP) therapy

 Ventricular assist devices (VADs)

 Transplant/Artificial Heart
 Implantable Cardioverter-Defibrillators
for HF
 .
Intraaortic Balloon Pump (IABP)
HeartMate II
Click here for UTube
Artificial Heart animination!