Heart failure

Prepared by: Karim Abdellatif

Table of contents

Introduction 01 02 Pathophysiology

Diagnosis 03 04Pharmacotherapy of heart

failure

05 Conclusions
Introduction

 Heart failure means that heart is

unable to pump blood around the
body properly because of certain
heart conditions.

 It can be acute or occur over time as

heart gets weaker (chronic kind) and
can affect one or both sides of heart.
 Introduction
There are two types of heart failure:
• Heart failure with reduced left ventricular function (HF-rEF)
• Heart failure with preserved left ventricular function (HF-pEF).
 Introduction
There are four stages of heart failure according to New
York Heart Association ((NYHA) Functional
Classification)
 Pathophysiology

 Compensatory mechanisms occurs when

there is a decrease in cardiac output.

 Only when this network of adaptations

becomes overwhelmed heart failure occur
.
Pathophysiology
1. Blood tests

• Brain natriuretic peptideexternal (BNP)

levels rise during heart failure.

• Blood tests can also show how well

liver and your kidneys are working.
 Diagnosis
2. Ejection fraction
 HF-rEF ( ejection fraction is 40% or less)
 HF-pEF (ejection fraction is 50% or more).
 Heart failure with borderline ejection fraction (ejection fraction is
somewhere in between (41% to 49%))
 3. Other tests
• CT scan, cardiac MRI, or nuclear heart
scan
• cardiac catheterization with coronary
angiography may be needed.
• ECG
• stress test
Pharmacotherapy of heart failure
Goals of therapy
1. Modify or control risk factors)
2. Manage structural heart disease
3. Reduce morbidity and mortality
4. Prevent or minimize Na and water retention
5. Eliminate or minimize HF symptoms
6. Slow progression of worsening cardiac
function
7. Block compensatory neurohormonal
activation caused by reduced cardiac output
(CO)
Pharmacotherapy of heart failure
 Diuretics
 Indicated in patients with evidence of fluid
retention
 Should be combined with ACEIs, β-blocker, and
aldosterone receptor antagonist

ACE inhibitors
 Recommended in all patients with HFrEF and
current or prior symptoms, unless
contraindicated.
ARBs
 Recommended in patients with HFrEF with
current or prior symptoms who are unable to
take an ACE inhibitor.
 β-blocker
 Recommended in with HFrEF with current or
prior symptoms unless contraindicated
 Add to existing ACE inhibitor therapy.
 Should not be prescribed without diuretics in
patients with current or recent history of fluid
retention.

Aldosterone receptor antagonists

 Recommended in patients with NYHA class II–IV
with an LVEF of 35% or less.
 Should be added to ACE inhibitor (or ARB) and β-
blocker therapy
 Eplerenone considered as an alternative to
spironolactone if gynecomastia occurred.
 Digoxin
 Digoxin is not indicated unless a patient is
symptomatic on optimal HF therapy.
 For most patients, 0.125 mg/day is adequate
to achieve the desired serum concentration.

Hydralazine, isosorbide dinitrate

 In addition to ACE inhibitors and β-blockers for
patients self-described as African American with
NYHA class III or IV HFrEF
 Sacubitril, valsartan
 Patients with chronic symptomatic NYHA
class II or III HFrEF who can tolerate an ACE
inhibitor or ARB.

Ivabradine
 For patients with symptomatic (NYHA class II and
III), stable, chronic HFrEF (LVEF of 35% or less) who
are receiving evidence-based therapies, including a
β-blocker at maximum tolerated dose, and who are in
sinus rhythm (SR) with an HR of 70 beats/minute or
greater at rest.
Pharmacotherapy of heart failure

Pharmacologic therapy of HFpEF

 Heart failure is a chronic progressive condition that cannot
usually be cured, but the symptoms can often be controlled for
many years.

 It should be treated according to the percentage of ejection

fraction which determine the type of heart failure.

 The goal of pharmacotherapy is to modify or control risk

factors, eliminate or minimize HF symptoms , slow progression
of worsening cardiac function, and block compensatory
neurohormonal activation caused by reduced cardiac output.
Thank you