HEART FAILURE PROF. DR. MUHAMMAD AKBAR CHAUDHRY M.R.C.P.(U.K)
F.R.C.P.(E) F.R.C.P.(LONDON) F.A.C.C. DESIGNED AT A.V. DEPTT
F.J.M.C. BY RABIA KAZMI
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HEART FAILURE Definitions Circulatory failure Heart failure
C.C.F. Pump failure Myocardial failure High output failure Forward
and backward failure Left & right heart failure Compensated
heart failure Atrial failure
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CLASSIFICATION OF PULMONARY EDEMA THE BASIS OF INITIATING
MECHANISIM
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CLASSIFICATION OF HEART FAILURE (NEW YORK HEART ASSOCIATION
FUNCTIONAL CLASSIFICATION) 1.Patients with cardiac disease but
without resulting limitations of physical activity.Ordinary
physical activity does not cause undue
fatigue,palpitations,dyspnea, or anginal pain. 2.Patients with
cardiac disease resulting in slight limitation of physical
activity.These patients are comfortable at rest. Ordinary physical
activity causes fatigue,palpitations,dyspnea,or anginal pain.
3.Patients with cardiac disease resulting in marked limitation of
physical activity. These patients are comfortable at rest.Less than
ordinary physical activity causes fatigue,palpitations,dyspnea,or
anginal pain. 4.Patients with cardiac disease resulting in
inability to carry on any physical activity without discomfort.
Symptoms of cardiac insufficiency or of the anginal syndrome may be
present even at rest.If any physical activity is undertaken
discomfort is increased.
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CLASSIFICATIONS & DEFINITIONS OF COMMON TYPES OF HEART
FAILURE Heart failure Clinical syndrome with classic symptoms that
are attributable to impaired myocardial function. Congestive heart
failure Similar but with features of circulatory congestion. Non
cardiac circulatory congestion Clinically similar syndrome but
without any structural heart disease. Systolic heart failure
Clinical syndrome with classic symptoms of heart failure whereby
dominant cardiac feature is dilated heart & impaired systolic
performance Diastolic heart failure Heart failure whereby the
dominant cardiac feature is impaired diastolic function. Right
sided heart failure Clinical syndrome characterized by marked
impairment of right ventricular systolic function,usually with
right ventricular dilatation & severe tricuspid
regurgitation.
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RIGHT HEART FAILURE AND SYSTEMIC CONGESTION
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LEFT HEART FAILURE AND PULMONARY CONGESTION
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SYSTOLIC HEART FAILURE Large,dilated heart Normal or low blood
pressure Broad age group; more common in men Low ejection fraction
S 3 gallop Systolic & diastolic impairment by echo Treatment
well established Poor prognosis Role of myocardial ischemia
important in selected cases DIASTOLIC HEART FAILURE Small LV
cavity, concentric LV hypertrophy Systemic hypertension Elderly
women more common Normal or increased ejection fraction S 4 gallop
Diastolic impairment by various Echo measurements Treatment not
well established Prognosis not as poor Myocardial ischemia common
THE DIFFERENTIAL DIAGNOSIS OF SYSTOLIC HEART FAILURE & HEART
FAILURE WITH NORMAL SYSTOLIC FUNCTION (DIASTOLIC HEART
FAILURE)
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CLASSIFICATION OF CIRCULATORY FAILURE & CIRCULATORY
OVERLOAD 1.Circulatry failure a)Heart (cardiac) failure b)Non
cardiac (peripheral) circulatory failure 1.Decreased return of
blood to heart, inadequate blood volume 2.Increased capacity of
vascular bed 3.Peripheral vascular abnormalities 4.Inadequate
oxyhemoglobin II.Circulatory congestion A.Cardiac circulatory
overload 1.Heart (cardiac) failure B.Non cardiac circulatory
overload 1.Increase in blood volume 2.Increase in venous return
& /or decrease in peripheral vascular resistance
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GENERAL CAUSES OF OVERALL HEART PUMP FAILURE A.Mechanical
abnormalities 1. Increased pressure load a) Central (aortic
stenosis, etc) b)Peripheral (systemic arterial hypertension,etc)
2.Increased volume load (valvular regurgitation,shunts, increased
venous return.etc) 3.Obstruction to ventricular filling (mitral or
tricuspid stenosis) 4.Pericardial constriction,tamponade
5.Endocardial or myocardial restriction 6.Ventricular aneurysm
7.Ventricular dyssynergy
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GENERAL CAUSES OF OVERALL HEART PUMP FAILURE B.Myocardial
(muscular) abnormalities or loss of myocytes 1.Primary
abnormalities or loss of myocytes a.Cardiomyopathy b.Neuromuscular
disorders c.Myocarditis d.Metabolic (diabetes mellitus. etc)
e.Toxic (alcohol, cobalt. etc) f.Presbycardia
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C. Secondary myocardial abnormalities or loss of myocytes
a.dysdynamic (secondary to mechanical abnormalities) b.Ischemia
(coronary heart disease) c.Metabolic d.Inflammation e.infiltrative
diseases f.Chronic obstructive lung disease g.Myocardial depression
due to drugs GENERAL CAUSES OF OVERALL HEART PUMP FAILURE
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D. Altered cardiac rhythm or conduction disturbances
1.Standstill 2.Fibrillation 3.Extreme tachycardia or bradycardia
4.Electrical asynchrony, conduction disturbances GENERAL CAUSES OF
OVERALL HEART PUMP FAILURE