HEART FAILURE
de Leon, Jan Gil
de los Santos, Rosheil
Ditti, Zah-Ara
Divinagracia, Joshua
Heart Failure
A
pathophysiological state in which an
abnormality of cardiac function is
responsible for the failure of the heart to
pump blood at a rate commensurate with
the requirements of the metabolizing
tissues.
Heart Failure
Heart Failure
The cardinal manifestations:
dyspnea and fatigue, which can limit exercise
tolerance
fluid retention, which can lead to pulmonary
congestion
and
peripheral
edema.
Heart Failure
Congestive Heart Failure
features of circulatory congestion (fluid
retention) :jugular venous distension, rales,
peripheral edema, and ascites.
Adjectives such as chronic, overt, treated,
untreated,
undulating,
worsening
and
compensated can precede the phrase.
Systolic Failure
HF with depressed EF
Diastolic Failure
HF with preserved EF
Right-Sided Heart Failure
A clinical syndrome characterized by tissue
congestion:
jugular
venous
distention,
peripheral edema, ascites, and abdominal organ
engorgement.
There is marked impairment of right ventricular
systolic performance, usually with right
ventricular dilatation and severe tricuspid
regurgitation.
Right-Sided Heart Failure
There are
syndrome:
multiple
causes
of
this
severe left-sided heart failure (the commonest
cause)
severe lung disease with chronic hypoxemia
and pulmonary hypertension (cor pulmonale)
right ventricular myocardial infarction
primary pulmonary hypertension
congenital abnormalities of the heart
Left-Sided Heart Failure
A clinical syndrome where the dominant feature
is fluid congestion in the lung (pulmonary
edema) rather than in the systemic circulation
Acute Heart Failure
Some physicians limit this term to a serious
medical emergency synonymous with acute
pulmonary edema
In recent years the meaning of the phrase has
been extended to include
new onset heart failure
worsening heart failure on a background of
chronic heart failure
Classification and Common Clinical Characteristics of Patients
with Acute Heart Failure
Clinical Classification
I Acute decompensated
congestive heart failure
Signs and
Symptom Onset Symptoms
Usually gradual
II Acute heart failure with Often very rapid
hypertension/hypertensive
crisis
Peripheral edema
(often significant),
dyspnea, usually
well-perfused
extremities
Dyspnea, altered
mental status,
possible
oliguria/anuria
Hemodynamics
SBP: Low
normal/high
CI: Low
normal/high
PCWP: Mildly
increased
SBP: High
(>180/100 mm Hg)
Other
Diagnostics
CXR: Normal or
mild interstitial
edema, possible
pleural effusion
CXR: Normal or
interstitial edema
CI: Usually normal
PCWP: >18 mm Hg
III Acute heart failure with Rapid or gradual
pulmonary edema
Severe dyspnea,
tachypnea,
tachycardia
SBP: Low normal
IVa Cardiogenic shock/low Usually gradual
output syndrome
Evidence of
hypoperfusion;
oliguria
SBP: Low normal
CI: Low, <2.2
liters/min/m2
PCWP: >16 mm Hg
SaO2: <90%
CXR: Alveolar
edema
Classification and Common Clinical Characteristics of Patients with Acute Heart Failure
Clinical Classification
IVb Severe
cardiogenic shock
Symptom Onset
Often rapid
Signs and
Symptoms
Marked
hypoperfusion;
oliguria/anuria
Hemodynamics
SBP: <90 mm Hg
CI: Very low, < 1.8
liters/min/m2
Other Diagnostics
Usually in presence
of severe
LV systolic
dysfunction
PCWP: >18 mm Hg
V High output failure Rapid or gradual
VI Right-sided acute Rapid or gradual
heart failure
Well-perfused
extremities; often
tachycardic
SBP: Variable
CI: Increased
PCWP: Normal or
increased
Edema, markedly
SBP: Low
elevated neck veins, CI: Low
often poor perfusion, PCWP: Low
but clear lungs
CXR: often clear lung
fields with evidence
of pulmonary
hypertension; BNP
may be elevated in
pulmonary embolus
Pathophysiology
Heart Failure: Staging
DIAGNOSIS AND TREATMENT
Diagnosis of the Syndrome
Chronic Heart Failure
Chronic Heart Failure
Treatment of CHF
Acute Heart Failure
Acute Heart Failure
Treatment of Acute
Heart Failure
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