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Heart Failure PowerPoint Presentation

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Description : This presentation is about Heart failure, heart failure definition, heart failure pathophysiology, heart failure medical treatment, heart failure mechanical treatment, heart failure device treatment, heart failure transplantation option and future hopes.

Tags : Heart failure, heart failure definition, heart failure pathophysiology, heart failure medical treatment, heart failure mechanical treatment, heart failure device treatment, heart failure transplantation option

Published on : Sep 29, 2020 | Views : 7997 | Downloads : 78

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Slide 1-

Heart failure Dr. Emhmed Elhemmali
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Heart Failure Definition Pathophysiology Medical Treatment Mechanical Treatment Device Treatment Transplantation Option Future Hopes
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Definition of Heart Failure HF is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood.
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New York Heart Association Classification Class I Physical activity is not limited and does not cause significant fatigue, heart palpitations, trouble breathing, or chest pain. Class II Physical activity is somewhat limited, You are comfortable at rest, but ordinary activity causes fatigue, heart palpitations, trouble breathing, or chest pain. Class III Physical activity is markedly limited, You are comfortable at rest, but less-than ordinary activities cause fatigue, heart palpitations, trouble breathing, or chest pain. Class IV All physical activity causes discomfort, Symptoms also are present at rest. Minor physical activity always makes symptoms worse.
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Character of Heart failure Signs and symptoms of intravascular and interstitial volume overload, including shortness of breath, rales, and edema. Manifestations of inadequate tissue perfusion, such as impaired exercise tolerance, fatigue, and renal dysfunction.
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Classical Symptoms of Heart Failure Fatigue or inability to exercise well; having less energy, feeling more tired than usual. Dyspnea at rest or exertion. Paroxysmal nocturnal dyspnea shortness of breath while sleeping or that wakes you at night. Orthopnea-Shortness of breath while lying down, gets worse when you lie flat. Cough – can be wet or dry, with crackles, and usually worse with lying down.. Weight gain. Swelling in the feet or ankles, usually worse at the end of the day or after standing for long periods; shoes may no longer fit. Sometimes edma is painful but usually pressure indents the skin. Abdominal swelling with decreased appetite and decreased muscle Cardiac Cachexia. Abdominal distention (Ascites) usually a sign of right heart failure. Urination: frequent urination, usually at night. Increased urination.
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Signs of heart failure Exertional dyspnea Orthopnea Gallup sounds Lung Crepitations Pulmonary edema Edema
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Acute Heart Failure Symptoms Caused by rapid fluid buildup in the lungs (pulmonary congestion), edema). Symptoms develop suddenly and may include: Severe shortness of breath. An irregular or rapid heartbeat. Coughing up foamy, pink mucus.
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Etiology: Ischemic Heart disease and Prior MI account for 2/3 of heart failure with reduced EF. Essential Hypertension is a major cause of ischemic and non ischemic heart failure reduced EF. Hypertension increases afterload and accelerates the progression of heart failure. HTN causes chronic pressure overload. genetic diseases, Toxic/drug induced, Immune mediated, infiltrative process, Metabolic disorders
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Common test ordered in HF medical history and a physical exam. Lab tests Electrocardiogram Chest X-ray. Echocardiogram Brain natriuretic peptide (BNP)/ TSH Nuclear stress test/MUGA Cardiac catheterization.
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Heart Failure with preserved EF HFpEF
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Heart Failure with preserved EF HFpEF Patients with symptoms and signs of Heart Failure with normal systolic function and diastolic dysfunction. • 30 to 50% of patients with Heart failure symptoms have normal LV systolic function. • Abnormal LV filling and elevated filling pressures. • Usually due to Impaired relaxation of the LV and increased stiffness of the cardiac muscle.
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Pathogenesis of Heart Failure with preserved EF ( HFpEF ) Pathologic Myocardial hypertrophy: HTN, Hypertrophic Cardiomyopathy Aging Ischemic fibrosis Restrictive Cardiomyopathy • Infiltrative disorders (Amyloid, Sarcoid) • Storage Diseases (Hemochromatosis) Endomyocardial disorders Valvular heart disease • (obstructive or regurgitation)
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Therapy: •Control of systolic and diastolic HTN •Control of atrial rate in patients with A fib • Control of pulmonary congestion and edema with diuretics • Coronary revascularization of patients with CAD, where ischemia causes worse diastolic function.
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Heart Failure with reduced EF HFrEF
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Heart Failure Pathophysiology
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Neurohormonal activation Decreased cardiac output activates. many neuro-hormonal compensatory. systems that in the short term act to preserve circulatory hemostasis and maintain arterial pressure. When in excess these systems play a role in worsening of HF.
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Medical Treatment of HFrEF What Improves Survival: ACE inhibitors Beta Blockers Spironolactone (Aldactone) /Eplenrone (Inspira) Hydralazine and Nitrates (V-Heft) Angiotensin Receptor Blockers (ARB) Device Therapy (AICD)
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DIURETICS Sodium and Water retention are the hallmark of CHF and diuretics are mandatory treatment for patients with pulmonary or Peripheral edema. Patients with CHF should be encouraged to weigh themselves daily.
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ACE inhibitors Diuretics activate the Renin Angiotensin system and should be given in combination with and ACE inhibitor. Correction of fluid overload with diuretics should be undertaken before starting an ACE inhibitor. Adding an ACE inhibitor to a patient on high dose diuretic may result in significant first dose hypotension.
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Beta Blocker In heart failure, the nervous system is over stimulated. Norepinephrine levels rise. Increased levels of circulating norepinephrine cause heart remodeling and arrhythmias. High levels of norepinephrine are directly toxic to heart cells and increase risk of death. Beta Blockers – block the toxic effect of nervous system over stimulation and norepinephrine.
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BETA-BLOCKERS BETA-BLOCKERS inhibit the adverse effects of chronic activation of the sympathetic nervous system acting on the myocardium Patients with minimal symptoms (NYHA 2) derive little symptomatic. Beta-BLOCKERS approved for the management of CHF are: ▪Carvedilol, Metoprolol and bisoprolol. ▪ All three drugs have been shown to prolong survival but they are not the same Benefit from beta blockers.
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Spironolactone and Epelnerone ALDOSTERONE RECEPTORS WITHIN THE HEART MEDIATE FIBROSIS, HYPERTROPHY AND ARRHYTHMOGENESIS REDUCTION IN ALL CAUSE MORTALITY AND SYMPTOMATIC RELIEF IN PATIENTS WITH ADVANCED CHF AT DOSES 25MGM/DAY
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Spironolactone and Epelnerone ●HYPERKALAEMIA,PARTICULARLY WHEN USED WITH ACE-INHIBITORS/ATRAs IN PATIENTS WITH IMPAIRED RENAL FUNCTION. ●MONITORING OF POTASSIUM LEVELS ESSENTIAL. ●USED IN COMBINATION WITH ACE INHIBITOR, LOOP DIURETIC +/- DIGOXIN.
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Digoxin BLOCKAGE OF THE SODIUMPOTASSIUM ATPase PUMP RESULTS IN INCREASED INOTROPIC RESPONSIVENESS THE DATA SUGGESTS THAT DIGOXIN HAS NO INFLUENCE ON SURVIVAL BUT REDUCES HOSPITALISATION AND IMPROVED THE QUALITY OF LIFE.
Slide 27-

Heart Failure Device Treatment Bi-Ventricular pacemaker helps improve cardiac output and improves symptoms. Automatic Implantable Defibrillator improves survival in patients with EF less than 35%. (Better than drug therapy alone)
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Heart Transplantation There were 2,125 heart transplants performed in the United States in 2005 and 2,016 in 2004. Each year thousands more adults would benefit from a heart transplant if more donated hearts were available. In the United States, 72.4 percent of heart transplant patients are male; 70.0 percent are white; 19.1 percent are ages 35-49 and 45.0 percent are ages 50-64.
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Future Heart Transplantation- A viable option for a select few patients. Left Ventricular Assist devices and the Artificial heart, are available options and used mainly as a bridge to transplant and not destination therapy. Stem cell transplantation and myocardial cell implantation have not yet proven viable.
Slide 30-

Drugs to avoid in heart failure NSAID – Ibuprophen, Naproxen . Cox-2 inhibitors (Celebrex) The NSAID can cause kidney to retain salt and water, and Interfere with ACE/ARB class. Use Acetemenphen Or Narcotics instead for pain and aches.
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Drugs to Avoid in CHF Anti-Arrhythmics in Class 1 ( Sodium Blockers and Class 3 , Potassium Channel blockers) The only heart rhythm drugs safe in Systolic dysfuction are Avoid Non Dihydropyridine Calcium Channel blockers. Non- dihydropridine Calcium Channel blockers (Verapamil & Diltiazem): decrease the strength of myocardial contractility and decrease heart rate. Verapamil and Diltiazem can worsen Heart failure and do not improve survival.
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