HEART FAILURE

ABDUL HAFIZ ALIAS

Heart failure (HF) is a clinical syndrome and represents the end stage of
most heart diseases.
3-20 per 1000 population

Prevalence in Malaysia

100 per 1000 population

Age group 65 years

70%

Coronary Artery Disease (CAD) and Hypertension (HTN)

are the main causes of HF among adults in Malaysia

5% to 52%

POOR PROGNOSIS.

6% - 10%

Cause of hospitalization of all acute medical admissions in

Malaysia.

25%

Hospital re-admissions within 30 days for acute

decompensation.

INTRODUCTION

 An abnormality of cardiac structure or function

leading to an impairment of ventricular filling or
ejection of blood. It is a clinical syndrome in which
patients have typical symptoms (e.g. breathlessness,
ankle swelling and fatigue) and signs (e.g. elevated
jugular venous pressure, ankle edema, pulmonary
crackles, and displaced apex beat). Occasionally some
patients may present without signs or symptoms of
volume overload.

DEFINITION

CO

HR

AFTERLOAD

SV

PRELOAD (EDV)

CONTRACTILITY

PATHOPHYSIOLOGY

AFTERLOAD
AL SV
Chronic hypertension

EF

SV

CONTRACTILITY
CONT SV

PL(EDV) SV

CAD/ chronic ischemic

Constrictive pericarditis

~ 55%

~EDV

SV

~EF

EDV

EDV
SV

PRELOAD (EDV)

EF
Systolic HF
(HFrEF)

Diastolic HF
(HFpEF)
5

 Pathophysiological Classification of Heart Failure

(HF)
CLASSIFICATION

LVEF%

I. Heart Failure with Reduced Ejection Fraction

(HFrEF)

40%

II. Heart Failure with Preserved Ejection Fraction

(HFpEF),borderline

41-49%

III Heart Failure with Preserved Ejection Fraction 50%

(HFpEF)

Most common
Coronary artery disease
Hypertension
Dilated cardiomyopathyidiopathic, familial
Valvular heart disease
Diabetic cardiomyopathy

Other causes

ETIOLOGY

Congenital heart disease

Cor pulmonale
Cardiac tamponade
Hypertrophic
cardiomyopathy
Viral myocarditis
Acute rheumatic fever
Toxic: Alcohol, adriamycin,
cyclophosphamide
Thyroid disease, acromegaly,
phaechromocytoma
SLE

 A clinical diagnosis based on a careful history and physical examination.

Symptoms

Breathlessness with orthopnoea

paroxysmal nocturnal dyspnoea (PND)
reduced exercise tolerance
ankle swelling

Signs

Elevated jugular venous pulse (JVP)

Third heart sound
Peripheral edema
Tachycardia
Narrow pulse pressure
Pulmonary crepitations
Hepatomegaly
Ascites.

DIAGNOSIS

 Acute HF - rapid onset of symptoms and signs of HF

due to an acute deterioration of cardiac function.
Chronic HF - chronic state when patients have stable
symptoms. In these patients an acute precipitating or
aggravating factor(s) may cause acute cardiac
decompensation.
Older terms such as congestive cardiac failure may be
used if patients present with both right and left
ventricular fluid overload.

12 lead ECG
Chest radiograph
Blood tests
Echocardiography
Tests for myocardial ischemia and/or viability:
treadmill exercise test, stress echocardiography (exercise or
pharmacological), radionuclide studies, cardiac magnetic
resonance imaging (CMR)
Invasive tests: coronary angiography, cardiac catheterization,
endomyocardial biopsy
Others: Holter, pulmonary function tests

INVESTIGATION

10

 Primary objective of management

What can be done?

Optimize underlying disease

Smoking cessation
Healthy lifestyle and diet
Regular physical exercise
Appropiate treat of coronary artery disease

PREVENTION

11

 Divide into acute and chronic

MANAGEMENT

12

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 CHRONIC HEART FAILURE

NON PHARMACOLOGICAL MEASURES

a) Education
b) Diet & Nutrition
c) Lifestyle
d) Exercise
e) Sleep Disorders
f) Social Support
PHARMACOLOGICAL MEASURES

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 Recognize patients who appear to be approaching the terminal phase of

their illness:

no identifiable reversible cause

been on optimum tolerated conventional drugs
worsening renal function
fail to respond to appropriate changes in diuretic and vasodilator drugs
sustained hypotension

In these patients it is important to :

explore their wishes in terms of options for care and place of care.
provide symptom relief.
discuss with patient and family when it would be appropriate to switch off
devices such as ICD or CRT
avoid inappropriate invasive procedures
discuss issues of Allow Natural Death (Do Not Resuscitate) with patient
and family.
provide physical, psychological, social and spiritual support of patient and
family support

END OF LIFE CARE

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 CPG Management of Heart Failure (3rd Edition) 2014

http://
www.heart.org/HEARTORG/Conditions/HeartFailure/Abou
tHeartFailure/Classes-of-Heart-Failure_UCM_306328_A
rticle.jsp
2013 ACCF/AHA Guideline for the Management of
Heart Failure - http://
circ.ahajournals.org/content/128/16/e240.extract

REFERENCES

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-TQ-

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