Overview of Heart Failure

Oleh:
dr. Kurniawan

Program Pendidikan Dokter Spesialis Ilmu Penyakit Dalam

Fakultas Kedokteran Universitas Udayana/RSUP Sanglah
• HF → clinical syndrome characterized by typical symptoms (e.g. breathlessness, ankle swelling
and fatigue) that may be accompanied by signs (e.g. elevated jugular venous pressure,
pulmonary crackles and peripheral oedema) + objective evidence of structural and/or functional
cardiac abnormality
• Structural and/or functional cardiac abnormality→ reduced cardiac output and/or elevated
intracardiac pressures.
• The cardinal manifestations of HF :
- dyspnea and fatigue → limit exercise tolerance
- fluid retention → pulmonary and/ or splanchnic congestion and/or peripheral edema.
• Term “Congestive heart failure” is no longer preferred, because many patients do not have
overt congestion at evaluation

• Yancy CW, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on
Practice Guidelines. J Am Coll Cardiol. 2013 Oct 15;62(16):e147-239.
• Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016 Jul 14;37(27):2129-2200.
• The global burden HF are approaching epidemic proportions, as evidenced by the
increase in the HF hospitalizations, mortality, and health care cost.

• The overall prevalence of HF is thought to be increasing, in part because current

therapies for cardiac disorders are allowing patients to survive longer.

• HF affects almost 23 million people worldwide. In The US its estimated 5.7 million
people have HF and its estimated that by 2030 the prevalence will incrase 25%

• The prevalence of HF rises exponentially with age.

Januzzi Jr JL, Mann DL. Approach to the Patient with Heart Failure. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF (eds). Braunwald’s Heart
Disease a Textbook of Cardiovascular Medicine. 11th eds. Philladelphia, PA, Elsevier; 2019.
• Stage: ACC/AHA staging
• Functional Classification: New York Heart Association (NYHA) class
• Onset: Acute vs Chronic
• Type of HF (ejection fraction): Preserved EF, Mid-range EF, Reduced
EF

Januzzi Jr JL, Mann DL. Approach to the Patient with Heart Failure. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF (eds). Braunwald’s Heart
Disease a Textbook of Cardiovascular Medicine. 11th eds. Philladelphia, PA, Elsevier; 2019.
Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016 Jul 14;37(27):2129-2200.
 Modyfing
Risk Factor

Treat structural •Washing, dressing,

heart disease or preparing meal
•Climb one flight of
stairs

Reduce
Mortality and
Morbidity

https://heart-failure.net/
https://www.wikidoc.org/index.php/COVID-19-associated_heart_failure
https://www.nursingtimes.net/clinical-
archive/cardiovascular-clinical-archive/heart-
failure-1-pathogenesis-presentation-and-
diagnosis-21-08-2017/
https://www.nursingtimes.net/clinical-archive/cardiovascular-clinical-
archive/heart-failure-1-pathogenesis-presentation-and-diagnosis-21-
08-2017/
• Hasenfuss G, Mann DL. Approach to the Patient with Heart Failure. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF (eds). Braunwald’s Heart Disease a Textbook of
Cardiovascular Medicine. 11th eds. Philladelphia, PA, Elsevier; 2019.
• LaCombe P, Jose A, Lappin SL. Physiology, Starling Relationships. [Updated 2021 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan
 The cardinal manifestations of HF :
- dyspnea and fatigue → limit exercise tolerance
- fluid retention → pulmonary and/ or splanchnic
congestion and/or peripheral edema.

• Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J.
2016 Jul 14;37(27):2129-2200.
• King M, Kingery J, Casey B. Diagnosis and evaluation of heart failure. Am Fam Physician. 2012 Jun 15;85(12):1161-8
Ezekowitz, Justin A. et al. 2017 Comprehensive Update of the CCS
Guidelines for the Management of Heart Failure. Can J Cardiol
2017;33:1342-1433.
Ezekowitz, Justin A. et al. 2017 Comprehensive Update of the CCS
Guidelines for the Management of Heart Failure. Can J Cardiol
2017;33:1342-1433.
McDonald M, et al. CCS/CHFS Heart Failure Guidelines Update: Defining a New
Pharmacologic Standard of Care for Heart Failure With Reduced Ejection Fraction.
Can J Cardiol. 2021 Apr;37(4):531-546.
• Riwayat angioedema
• Stenosis renal bilateral
• Stenosis aorta berat
• Kadar kalium serum >5,5 mmol/L
• Serum kreatinin > 2,5 mg/dL
(relatif)

• Asma berat
• Blok AV derajat 2 dan 3
• Sick sinus syndrome
• sinus bradikardia (<50 bpm)

• Hiperkalemia
• Perburukan fungsi ginjal
• Ginekomastia
• Dalam 36 jam penggunaan ACEI
• Angioedema dengan ACEI/ARB sebelumnya
• Kehamilan/Menyusui Ponikowski P, et al. 2016 ESC Guidelines for
the diagnosis and treatment of acute and
• Sirosis CTP C chronic heart failure. Eur Heart J. 2016 Jul
• Diketahui hipersensitifitas pada ACEI/ARB 14;37(27):2129-2200.
• https://www.wikidoc.org/index.php/COVID-19-associated_heart_failure
• Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute
and chronic heart failure. Eur Heart J. 2016 Jul 14;37(27):2129-2200.
 A B

D C

• Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016 Jul 14;37(27):2129-2200.
 High probability Intermediate probability Low probability

Patients with history of Patients with no history Dyspneu

HF: of HF but have: +
- Exertional dysnea - known cardiac disease Lack evidence of
- Fluid retention or cardiac disease
- Cardiac risk factor or +
Patients without history - ECG abnormalities Normal ECG
of HF: + +
- New onset orthopnea Uncertain JVP and no Have another
- Elevated JVP pulmonary edema explanation for dyspnea
↓ ↓
- Typical chest xray
BNP/NT-proBNP and BNP/NT-proBNP indicated
- No Fever Echo

Approach to Acute decompensated heart failure. Uptodate

https://www.radiologymasterclass.co.uk/gallery/chest/cardiac_disease/pulmonary_oedema
https://mcatmemoranda.tumblr.com/post/179059573801/bats-wing-or-butterfly-pulmonary-opacities-refer
Ezekowitz, Justin A. et al. 2017 Comprehensive Update of the CCS Guidelines for the Management of Heart Failure. Can J Cardiol 2017;33:1342-1433.
Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute
and chronic heart failure. Eur Heart J. 2016 Jul 14;37(27):2129-2200.
Ezekowitz, Justin A. et al. 2017 Comprehensive Update of the CCS Guidelines for
the Management of Heart Failure. Can J Cardiol 2017;33:1342-1433.
Ponikowski P, et
al. 2016 ESC
Guidelines for
the diagnosis
and treatment of
acute and
chronic heart
failure. Eur Heart
J. 2016 Jul
14;37(27):2129-
2200.
• HF is a clinical syndrome characterized by typical symptoms + signs + objective
evidence of structural and/or functional cardiac abnormality.
• The cardinal manifestations of HF :
- dyspnea and fatigue → limit exercise tolerance
- fluid retention → pulmonary and/ or splanchnic congestion and/or peripheral
edema.
• Term “Congestive heart failure” is no longer preferred, because many patients do
not have overt congestion at evaluation.
• ARNI + Beta Blocker + MRA + SGLT-2 now is became a 4 pillar of management of
CHF.
Terima Kasih