Heart Failure: Living with a Hurting Heart. Congestive Heart Failure Heart (or cardiac) failure is...
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Transcript of Heart Failure: Living with a Hurting Heart. Congestive Heart Failure Heart (or cardiac) failure is...
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Heart Failure: Living with a Hurting Heart
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Congestive Heart Failure
• Heart (or cardiac) failure is the state in which the heart is unable to pump blood at a rate commensurate with the requirements of the tissues or can do so only from high pressures
Braunwald 8th Edition, 2001
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Heart Failure Heart
A heart failure heart has a reduced ability to pump blood.
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CAD=coronary artery disease; LVH=left ventricular hypertrophy.
Risk Factors for Heart Failure
• Coronary artery disease
• Hypertension (LVH)• Valvular heart
disease• Alcoholism• Infection (viral)
• Diabetes• Congenital heart defects• Other:
– Obesity– Age– Smoking– High or low hematocrit level– Obstructive Sleep Apnea
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Classification of HF: Comparison Between ACC/AHA HF Stage and
NYHA Functional Class
1Hunt SA et al. J Am Coll Cardiol. 2001;38:2101–2113.
2New York Heart Association/Little Brown and Company, 1964. Adapted from: Farrell MH et al. JAMA. 2002;287:890–897.
ACC/AHA HF Stage1 NYHA Functional Class2
A At high risk for heart failure but withoutstructural heart disease or symptomsof heart failure (eg, patients withhypertension or coronary artery disease)
B Structural heart disease but withoutsymptoms of heart failure
C Structural heart disease with prior orcurrent symptoms of heart failure
D Refractory heart failure requiringspecialized interventions
I Asymptomatic
II Symptomatic with moderate exertion
IV Symptomatic at rest
III Symptomatic with minimal exertion
None
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How Heart Failure Is Diagnosed
• Medical history is taken to reveal symptoms• Physical exam is done• Tests
– Chest X-ray– Blood tests– Electrical tracing of heart (Electrocardiogram or “ECG”)– Ultrasound of heart (Echocardiogram or “Echo”)– X-ray of the inside of blood vessels (Angiogram)
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Heart Failure Treatments: Medication Types
• ACE inhibitor (angiotensin-converting enzyme)
• ARB (angiotensin receptor blockers)
• Beta-blocker
• Digoxin
• Diuretic
• Aldosterone blockade
Type What it does• Expands blood vessels which
lowers blood pressure, neurohormonal blockade
• Similar to ACE inhibitor—lowers blood pressure
• Reduces the action of stress hormones and slows the heart rate• Slows the heart rate and improves the heart’s pumping function (EF)
• Filters sodium and excess fluid from the blood to reduce the heart’s workload
• Blocks neurohormal activation and controls volume
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Device Therapy:Biventricular Pacing
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Overview of Device Therapy 9
Biventricular PacingVentricular Dysynchrony
• Abnormal ventricular conduction resulting in a mechanical delay and dysynchronous contraction
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BiV Pacing
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Cardiac Resynchronization TherapyKey Points
• Indications– Moderate to severe CHF who have failed optimal
medical therapy– EF<30%– Evidence of electrical conduction delay
• Timing of Referral Important– Patients often not on optimal Medical Rx– Patients referred too late- Not a Bail Out
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Defibrillators (ICD’s)
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Heart Failure and Sudden Cardiac Death
Sudden Cardiac Death (SCD) – Your heart suddenly goes into a very fast and chaotic
rhythm and stops pumping blood
– Caused by an “electrical” problem in your heart
– SCD is one of the leading causes of death in the U.S. – approximately 450,000 deaths a year
– Patients with heart failure are 6-9 times as likely to develop sudden cardiac death as the general population
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How does a defibrillator for sudden cardiac death work?
Device Shown:
Combination Pacemaker & Defibrillator
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Implantable Cardiac Defribrillators
EBM Therapies Relative RiskReduction
Mortality2 year
ACE-I 23% 27%
Β-Blockers 35% 12%
Aldosterone Antagonists
30% 19%
ICD 31% 8.5%
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Who should Consider an ICD?• Patients with weakend heart, New York
Heart Association (NYHA) Class II and III heart failure, and measured left ventricular ejection fraction (LVEF) < 35%
• Patients who meet all current requirements for a cardiac resynchronization therapy (CRT) device and have NYHA Class IV heart failure;
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Other Therapies?
• Transplant• Artificial hearts• New “gadgets” to help doctors manage
heart failure
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Heart Transplantation
• A good solution to the failing heart– get a new heart
• Unfortunately we are limited by supply, not demand
• Approximately 2200 transplants are performed yearly in the US, and this number has been stable for the past 20 years.
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Worldwide Heart Transplants
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Newer Generation Artificial Hearts
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Future Tech
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Intrathoracic Impedance for Heart Failure
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One of the Best Devices for Monitoring Heart Failure
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What have we learned?
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In Summary….
• Heart failure is common and has high mortality• Drug therapy improves survival
– Betablockers, ACE-I, aldosterone antagonists
• Newer device therapies are showing promise for symptom relief and improved survival– Biventricular pacing, ICD’s
• Transplants remain rare, but technology for mechanical assist devices continues to improve- stay tuned!