HEART FAILURE

1. Definition
a. Syndrome yang disebabkan adanya structural / functional cardiac disorder yang
mempengaruhi ventricle buat isi/eject blood
b. Ciri - ciri : dyspnea, fatigue, & tanda volume overload (peripheral edema,
pulmonary rales)
c. Gejala HF → bikin dysfunction systolic / diastolic
d. Common causes :
i. Coronary artery disease
ii. HTN
iii. Idiopathic (cardiomyopathy)
iv. Valvular disease
v. Alcohol

2. Patophysiology

a.
b. RHF - diastolic
i. Pitting edema
 ii. Ascites
iii. Anorexia
iv. GI distress
v. BB turun
vi. Impaired liver function
c. LHF - systolic
i. Cyanosis
ii. Sign of hypoxia
iii. Pulmo edema :
1. Cough with frothy sputum
2. Orthopnea (sesak saat tiduran)
3. PND

3. Risk Factor
a. DM
b. HT
c. Valvular heart disease
d. Smoking
e. Obese
f. Low status social economic

4. Klasifikasi
a. NYHA CLASS
NYHA Symptoms : fatigue, palpitations, chest pain, dyspnea, syncope
Class

I No symptoms​ with ​normal​ physical activity

Normal functional ​status

II Mild symptoms ​with ​normal​ physical activity

Comfortable at rest
Slight limitation​ of f​ unctional​ status

III Moderate symptoms​ with ​less​ than normal physical activity

Comfortable ​only​ at rest
Marked​ ​limitation​ of ​functional​ status

IV Severe symptoms ​with features of HF with ​minimal​ physical

activity and ​even at rest
Severe limitation​ of functional status

5. Gejala
 a.
b. PF:
i. Skin :
1. Pallor
2. Cyanosis
ii. Neck :
1. Increase JVP
iii. Extremities :
1. Cool
2. Pitting peripheral edema
iv. Lungs :
1. Laboured breathing
2. Rales
v. Heart :
1. Bradicardia / tachycardia
2. Laterally ​displaced​ point of max
3. Impulse
4. 3rd heart sound + → gallop / murmur
vi. Abdomen
1. Hepatojugular reflux
2. Ascites

6. Pemeriksaan Penunjang
a. Lab
i. BNP​ : normal <95 ng/mL)
1. Disekresi di atria dan ventricle pada saat stretch / ventricle tension
tinggi
ii. NT pro-BNP : normal <642 ng/mL
1. Untuk menilai dyspnea pada HF
b. Criteria
i. Framingham Criteria​ for HF : 2 major OR 1 major & 1 minor
1.
 Major Criteria Minor Criteria

Acute pulmonary edema Ankle edema

Cardiomegaly Dyspnea on exertion

Hepatojugular reflux Hepatomegaly

Neck vein distension Nocturnal cough

Paroxysmal nocturnal dyspnea Pleural effusion

/ orthopnea

Rales Tachycardia >120 bpm

3rd heart sound (gallop)

c. Chest radiography
i. X​ ​ray​ : cardiomegaly , pleural effusion, redistribution, Kerley B lines,
bronchiolar alveolar cuffing
ii. Echocardiograph​ : systolic function (LVEF), diastolic function, cardiac
dimensions, wall motion abnormalities, valvular disease, pericardial
effusion

7. Algorithm Acute Heart Failure

a. Acute HF : rapid onset / worsening of symptoms and/or congestion sign of HF
 b.

8. Treatment
a. RAAS blockade
i. ACEI
ii. Angiotensin II receptor blockers
b. Beta blocker
c. Mineralocorticoid receptor (aldosterone) antagonist :
d. Diuretics : furosemide
e. Digoxin and cardiac glycoside
f. Antiarrhytmic drugs : amiadarone, beta blocker, or digoxin
g. Anticoagulants : warfarin