HEART FAILURE

Outline:
Data and Definition
Classifications
AHA/ACC and NYHA
Cardiac output
Pathophysiology
Assessment
Management
Learning Objectives:
Describe and understand Heart Failure
Describe the classification systems used to define
heart failure
Explain the physiologic basis for the clinical
manifestations of heart failure
Explain the standard pharmacological therapies for
the chronic heart failure, and their rationale.
Describe the non-pharmacological therapies for
management of heart failure
Define the expected outcomes for the therapeutic
management of patients with heart failure
Formulate a teaching plan for patients and families
regarding heart failure.
Demographics
5.8 million Americans live with heart failure
Incidence of heart failure approaches 10 per
1000 population after age 65 years, and
75% have antecedent hypertension.
Heart failure is the most common diagnosis
in the intensive care unit (ICU)
Cardiac diseases-major cause of mortality
and morbidity among Filipinos.
Definition
Heart failure:
Clinical syndrome characterized by:
Shortness of breath
Dyspnea on exertion
Paroxysmal nocturnal dyspnea or orthopnea
Peripheral or pulmonary edema (congestive
heart failure)
Classifications
Acute vs Chronic
Left-sided vs Right-sided
NYHA vs ACC/AHA

Normal Anatomical Condition
Normal anatomy of the heart
Circulation
Left-sided vs Right-sided HF
Left-sided
Failure of left ventricle to
fill in properly
Leads to increased
pressure inside the
ventricles and congestion
in pulmonary vascular
system
Can be classified as
systolic or diastolic
dysfunction
Right-sided
Failure of right ventricle to
pump adequately
Commonly caused by
left-sided failure
Can also result from
pulmonary disease and
primary pulmonary artery
hypertension (cor
pulmonale)
NYHA Heart Failure Classification
New York Heart Association Classification
(NYHA)

I SOB on more than ordinary activities
II- SOB on ordinary activities
III- SOB on less than ordinary activities
IV- SOB even at rest

Classification
New York Heart Association AHA/ACC
Factors affecting Cardiac Output
Pathophysiology
Assessment
Assessment
Myocardial Hypertrophy
Diagnosis & Management:
Diagnostic tests:
Chest x-ray
ECG
Echocardiogram
Cardiac stress tests
Heart CT scan
Heart catheterization
MRI of the heart
Nuclear heart scans

Blood chemistry
BUN
Complete blood count
Creatinine
Creatinine clearance
Liver function tests
Uric acid
Sodium
Urinalysis

Management:
On severe cases- endotracheal intubation
Aggressive diuresis
Cardiac output optimization
Fluids
Inotropes and inodilators
Vasodilators
Measures to optimize heart rate
Antibiotics therapy in cases of pulmonary
infection
Nutrition
Prevention of symptoms