Heart FailureHeart Failure

Definition:Definition:

It represents the failure of the heart to It represents the failure of the heart to supply adequate blood flow and, hence, supply adequate blood flow and, hence, nutrients and oxygen to metabolizing nutrients and oxygen to metabolizing

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Types of heart failureTypes of heart failure

1. High output vs low output failure:1. High output vs low output failure:

► High output heart failure in:High output heart failure in:AnaemiaAnaemiaHyperthyroidismHyperthyroidism

► Low output failure in:Low output failure in:

HypertensionHypertension

CHDCHD

CardiomyopathiesCardiomyopathies

2. Right-sided vs left-sided heart failure2. Right-sided vs left-sided heart failure

Important causes of left and right heart failure:Important causes of left and right heart failure:

* Left heart failure:* Left heart failure:

1.1. Ischaemic heart diseaseIschaemic heart disease

2.2. Rheumatic heart disease (MR – AS - AR)Rheumatic heart disease (MR – AS - AR)

3.3. HypertensionHypertension

4.4. CardiomyopathyCardiomyopathy

5.5. Congenital heart disease ( VSD – PDA)Congenital heart disease ( VSD – PDA)

* Right heart failure:* Right heart failure:

1.1. Secondary to lung diseaseSecondary to lung disease

2.2. Multiple pulmonary emboliMultiple pulmonary emboli

3.3. Rheumatic tricuspid valve disease Rheumatic tricuspid valve disease (rarely)(rarely)

4.4. Congenital heart disease (ASD – Any Congenital heart disease (ASD – Any cyanotic heart disease with right to cyanotic heart disease with right to left shunt)left shunt)

► Congestive heart failure (right heart failure Congestive heart failure (right heart failure 2ry to left heart failure) must be 2ry to left heart failure) must be distinguished from cor-pulmonale ( right distinguished from cor-pulmonale ( right heart failure 2ry to lung disease)heart failure 2ry to lung disease)

► The symptoms and signs in these 2 The symptoms and signs in these 2 conditions can be very similar, and the 2 conditions can be very similar, and the 2 may co-exist.may co-exist.

Symptoms and signs of left Symptoms and signs of left heart failureheart failure

► DyspneaDyspnea►OrthopneaOrthopnea►Paroxysmal nocturnal dyspneaParoxysmal nocturnal dyspnea►Signs of pulmonary congestion (basal Signs of pulmonary congestion (basal

lung crepitations – pink frothy sputum)lung crepitations – pink frothy sputum)►Cardiac asthma (wheezy chest)Cardiac asthma (wheezy chest)►Pulmonary oedema (Bubbling Pulmonary oedema (Bubbling

crepitations)crepitations)

Symptoms and signs of right Symptoms and signs of right heart failureheart failure

►Congested neck veinsCongested neck veins►Hepatomegaly (tender enlarged liver – Hepatomegaly (tender enlarged liver –

dyspepsia)dyspepsia)►Peripheral oedemaPeripheral oedema►Pleural effusion & ascites in advanced Pleural effusion & ascites in advanced

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