CASE

A 66-YEAR-OLD WOMEN PRESENTS TO YOUR OFFICE COMPLAINING OF SHORTNESS OF BREATH AND BILATERAL LEG
EDEMA THAT HAVE BEEN WORSENING FOR 3 MONTHS. SHE EMPHATICALLY TELLS YOU, I GET OUT OF BREATH WHEN I DO
HOUSEWORK AND I CANT EVEN TALK TO THE CORNER. SHE HAS ALSO NOTICED DIFFICULTY SLEEPING SECONDARY TO A
DRY COUGH THAT WAKES HER UP AT NIGHT AND FURTHER EXACERBATION OF HER SHORTNESS OF BREATH WHILE LYING
FLAT. THIS HAS FORCED HER TO USE THREE PILLOWS FOR A GOOD NIGHTS SLEEP. SHE DENIES ANY CHEST PAIN,
WHEEZING, OR FEBRILE ILLNESS. SHE HAS NO PAST ILLNESSES AND TAKES NO MEDICATIONS. SHE IS NEVER SMOKED
AND DRINKS SOCIALLY. ON EXAMINATION, HER BLOOD PRESSURE IS 187/90 MMHG, HER PULSE IS 97 BPM, HER
RESPIRATORY RATE IS 16 BREATHS PER MINUTE, HER TEMPERATURE IS 980F (36.60C)AND HER OXYGEN SATURATION
IS 93% ON ROOM AIR BY PULSE OXIMETRY. SHE HAS A PRONOUNCED JUGULAR VEIN. CARDIAC EXAMINATION REVEALS A
PANSYSTOLIC MURMUR. EXAMINATION OF HER LUNG BASES PRODUCES DULLNESS BILATERALLY. YOU FIND 2+ PITTING
EDEMA OF BOTH ANKLES. AN ECG SHOWS A NORMAL SINUS RHYTHM AND A CHEST X-RAY DEMONSTRATES MILD
CARDIOMEGALY WITH BILATERAL PLEURAL EFFUSIONS. YOU DECIDE SHE NEEDS FURTHER WORKUP, SO YOU CALL THE
HOSPITAL WHERE YOU HAVE ADMITTING PRIVILEGES AND ARRENGE FOR A TELEMETRY BED.
DEFINITION

HEART FAILURE IS A CONDITION WHERE THE HEART IS NOT ABLE TO PUMP BLOOD TO THE REST OF THE
BODY AT A NORMAL RATE.
ETIOLOGY
STRUCTURAL DAMAGE TO THE HEART
INABILITY OF THE HEART TO SQUEEZE PROPERLY
MEDICATIONS OR DRUGS THAT AFFECT HEART FUNCTION
LUNG DISEASE
OTHER UNDERLYING MEDICAL DISEASES
MOST COMMONLY : WEAKNESS OF THE MUSCLE OF THE LEFT VENTRICLE
RISK FACTOR
AGE
GENDER
ETHNICITY
FAMILY HISTORY AND GENETICS
DIABETES
OBESITY
LIFESTYLE FACTORS
CLASSIFICATIONS
THE NEW YORK HEART ASSOCIATION (NYHA)
CLASS I
CLASS II
CLASS III
CLASS IV
 SYMPTOMS

SHORTNESS OF BREATH(DYSPNEA,ORTHOPNEA, PAROXYSMAL OR INTERMITTENT NOCTURNAL DYSPNEA)

BUILDUP OF FLUID IN THE LUNGS
BUILDUP OF EXCESS FLUID (EDEMA) IN OTHER PARTS OF THE BODY
FATIGUE, WEAKNESS, AND AN INABILITY TO EXERT ONESELF PHYSICALLY OR MENTALLY
BLUENESS OF THE SKIN (CYANOSIS)
DIAGNOSIS
HISTORY: SYMPTOM, PAST MEDICAL HISTORY, MEDICATION HISTORY, DIET, AND SOCIAL HISTORY
PHYSICAL EXAMINATION: VITAL SIGN, LUNGS EXAM, HEART EXAM, NECK (JVP), PERIPHERAL EDEMA,
ABDOMINAL EXAMINATION
INVESTIGATION: EKG, CHEST X-RAY, BLOOD TESTS, B-TYPE NATRIURETIC PEPTIDE (BNP),
ECHOCARDIOGRAPHY
COMPLICATION
KIDNEY DAMAGE OR FAILURE
HEART FAILURE CAN REDUCE THE BLOOD FLOW TO YOUR KIDNEYS, WHICH CAN EVENTUALLY CAUSE
KIDNEY FAILURE IF LEFT UNTREATED. KIDNEY DAMAGE FROM HEART FAILURE CAN REQUIRE DIALYSIS FOR
TREATMENT
HEART VALVE PROBLEMS
LIVER DAMAGE
STROKE.
TREATMENT
DIET AND LIFESTYLE
DECREASE SALT AND WATER
AMOUNT OF DRINK
WEIGH YOURSELF EVERY DAY
CONTROL YOUR WEIGHT
LIMIT ALCOHOL
CARDIAC REHAB AND EXERCISE
CONTINUE
MEDICINE
ACE INHIBITOR OR ARBS : BENAZEPRIL OR CAPTOPRIL.
DIURETICS: LOOP-DIURETICS (FUROSEMIDE) OR HCT
BETA BLOCKER: CARVEDILOL
BLOOD THINNER: WARFARIN

HEART RHYTHM TREATMENT

AN IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR (ICD)
CARDIAC RESYNCHRONIZATION THERAPY (CRT) OR BIVENTRICULAR PACING
CONTINUE
SURGERY OR STENTING
HEART VALVE SURGERY
CORONARY ARTERY BYPASS GRAFT (CABG) SURGERY

TREATMENT FOR ADVANCED HEART FAILURE

HEART TRANSPLANTATION
PROGNOSIS

STABLE CHF : GOOD

BAD CHF : MORTALITY RISK >20% AT 1 YEAR
NYHA STAGE IV FAILURE: MORTALITY RATE UP TO 50%
EDUCATION
CONTROL HIGH PRESSURE
EAT A HEALTHY DIET AND LIFE STYLE CHANGES
EXERCISE
CONTROL BLOOD SUGAR LEVELS (ESPECIALLY IF YOU HAVE DIABETES)
MAINTAIN GOOD BLOOD CHOLESTEROL LEVELS
QUIT SMOKING AND ALKOHOL
CONCLUTION
CONGESTIVE HEART FAILURE (CHF), OCCURS WHEN THE HEART IS UNABLE TO PROVIDE SUFFICIENT PUMP
ACTION TO MAINTAIN BLOOD FLOW TO MEET THE NEEDS OF THE BODY.
HEART FAILURE IS A COMMON, COSTLY, DISABLING, AND POTENTIALLY DEADLY CONDITION. IN DEVELOVED
COUNTRIES, AROUND 2% ADULTS SUFFER FROM HEART FAILURE, BUT IN THOSE OVER AGE 65, THIS
INCREASES TO 6-10%.