CARDIAC FAILURE

• PATHOPHYSIOLOGY
• CAUSES
• DIAGNOSIS
• CLASSIFICATION
• TREATMENT
• Heart failure occurs when the heart muscle is weakened and cannot
pump enough blood to meet the body's needs for blood and oxygen.
• when the heart is unable to pump sufficiently to maintain blood
flow to meet the needs of the body
• Congestive heart failure (CHF) / congestive cardiac failure (CCF)
• The structure or the functioning of the heart might be altered.
• Heart failure is caused by any condition reduces the efficiency of the
myocardium through damage or overloading
• Changes at cellular level & neuro-hormonal interactions with other
organ
• Hemodynamic changes: decreased output (systolic dysfunction) decreased
filling (diastolic dysfunction)
• Neuro-hormonal changes : sympathetic system activation, cytokines release
• Cellular changes: inefficient Ca2+, cell death
• Systolic dysfunction – reduce stroke volume (SV) with decrease in
Cardiac output (CO)
• Diastolic dysfunction – decrease relaxation, decreased elastic recoil,
increased stiffness of the heart
• Cytokines – protein group release by WBC in response to injury.
Interleukins (ILs) and tumor necrosis factor (TNF).
DR MANAGEMENT - DIAGNOSIS
• history of the symptoms
• physical examination
•  echocardiography
• to determine the stroke vol (the amount of blood in the heart that exits the
ventricles with each beat), the end-diastolic vol (the total amount of blood at
the end of diastole), and LV ejection fraction (EF) (%)
• Electrocardiography (ECG)
• used to identify arrhythmias, ischemic heart disease, right or left ventricular
hypertrophy
• Chest radiograph
• used to aid in the diagnosis of CHF
• may show cardiomegaly (visible enlargement of the heart)
• Blood test
• An elevated B-type natriuretic peptide (BNP) is a specific test indicative of
heart failure. 
CLASSIFICATION

Functional classification generally relies on the New York Heart

Association functional classification. The classes (I-IV) are:
TREATMENT
• Treatment depends on the severity and cause of the disease
• First-line therapy for all heart failure patients is angiotensin-
converting enzyme (ACE) inhibition which improve survival and
quality of life in heart failure patients
• In patients with severe cardiomyopathy (LVEF below 35%),
implantation of an automatic implantable cardioverter defibrillator
 (AICD) should be considered to reduce the risk of severe life-
threatening arrhythmias.
• At end stage, cardiac transplant can be considered
• The patient generally must remain on an immunosuppressive regimen
to prevent rejection
• Some patients may also be candidates for ventricular assist device,
which have commonly been used as a bridge to heart transplants.
Additional info
• Congenital – born with diseases
• Ejection fraction – equals the amount of blood pumped out of the ventricles
with contraction. Stroke volume divided by end-diastolic volume. MALE ( 52%
- 72%), FEMALE (54% - 74%).
• Ascites – fluid in peritoneal cavity (space within abdomen)
• Arrhythmia – irregular rhythm of heartbeat.