HEART FAILURE

de Leon, Jan Gil

de los Santos, Rosheil
Ditti, Zah-Ara
Divinagracia, Joshua

Heart Failure
A

pathophysiological state in which an

abnormality of cardiac function is
responsible for the failure of the heart to
pump blood at a rate commensurate with
the requirements of the metabolizing
tissues.

Heart Failure

Heart Failure

The cardinal manifestations:

dyspnea and fatigue, which can limit exercise
tolerance
fluid retention, which can lead to pulmonary
congestion
and
peripheral
edema.

Heart Failure

Congestive Heart Failure

features of circulatory congestion (fluid
retention) :jugular venous distension, rales,
peripheral edema, and ascites.
Adjectives such as chronic, overt, treated,
untreated,
undulating,
worsening
and
compensated can precede the phrase.

 Systolic Failure
HF with depressed EF

Diastolic Failure
HF with preserved EF

Right-Sided Heart Failure

A clinical syndrome characterized by tissue
congestion:
jugular
venous
distention,
peripheral edema, ascites, and abdominal organ
engorgement.
There is marked impairment of right ventricular
systolic performance, usually with right
ventricular dilatation and severe tricuspid
regurgitation.

Right-Sided Heart Failure

There are
syndrome:

multiple

causes

of

this

severe left-sided heart failure (the commonest

cause)
severe lung disease with chronic hypoxemia
and pulmonary hypertension (cor pulmonale)
right ventricular myocardial infarction
primary pulmonary hypertension
congenital abnormalities of the heart

Left-Sided Heart Failure

A clinical syndrome where the dominant feature
is fluid congestion in the lung (pulmonary
edema) rather than in the systemic circulation

Acute Heart Failure

Some physicians limit this term to a serious
medical emergency synonymous with acute
pulmonary edema
In recent years the meaning of the phrase has
been extended to include
new onset heart failure
worsening heart failure on a background of
chronic heart failure

Classification and Common Clinical Characteristics of Patients

with Acute Heart Failure
Clinical Classification
I Acute decompensated
congestive heart failure

Signs and
Symptom Onset Symptoms
Usually gradual

II Acute heart failure with Often very rapid

hypertension/hypertensive
crisis

Peripheral edema
(often significant),
dyspnea, usually
well-perfused
extremities
Dyspnea, altered
mental status,
possible
oliguria/anuria

Hemodynamics
SBP: Low
normal/high
CI: Low
normal/high
PCWP: Mildly
increased
SBP: High
(>180/100 mm Hg)

Other
Diagnostics
CXR: Normal or
mild interstitial
edema, possible
pleural effusion

CXR: Normal or
interstitial edema

CI: Usually normal

PCWP: >18 mm Hg

III Acute heart failure with Rapid or gradual

pulmonary edema

Severe dyspnea,
tachypnea,
tachycardia

SBP: Low normal

IVa Cardiogenic shock/low Usually gradual

output syndrome

Evidence of
hypoperfusion;
oliguria

SBP: Low normal

CI: Low, <2.2
liters/min/m2
PCWP: >16 mm Hg

SaO2: <90%
CXR: Alveolar
edema

Classification and Common Clinical Characteristics of Patients with Acute Heart Failure

Clinical Classification
IVb Severe
cardiogenic shock

Symptom Onset
Often rapid

Signs and
Symptoms

Marked
hypoperfusion;
oliguria/anuria

Hemodynamics
SBP: <90 mm Hg
CI: Very low, < 1.8
liters/min/m2

Other Diagnostics
Usually in presence
of severe
LV systolic
dysfunction

PCWP: >18 mm Hg
V High output failure Rapid or gradual

VI Right-sided acute Rapid or gradual

heart failure

Well-perfused
extremities; often
tachycardic

SBP: Variable
CI: Increased

PCWP: Normal or
increased
Edema, markedly
SBP: Low
elevated neck veins, CI: Low
often poor perfusion, PCWP: Low
but clear lungs

CXR: often clear lung

fields with evidence
of pulmonary
hypertension; BNP
may be elevated in
pulmonary embolus

Pathophysiology

Heart Failure: Staging

DIAGNOSIS AND TREATMENT

Diagnosis of the Syndrome

Chronic Heart Failure

Chronic Heart Failure

Treatment of CHF

Acute Heart Failure

Acute Heart Failure

Treatment of Acute
Heart Failure

Thank you for listening