CONGESTIVE HEART FAILURE HEART FAILURE DEFINITION It is

CONGESTIVE HEART FAILURE

HEART FAILURE - DEFINITION It is a clinical syndrome that occurs in patients who, because of an inherited or acquired abnormality of cardiac structure and/or function, develop a constellation of clinical symptoms (dyspnea and fatigue) and signs (edema and rales) that lead to frequent hospitalizations, a poor quality of life, and a shortened life expectancy.

EPIDEMIOLOGY Overall prevalence worldwide in adults – 2% and is increasing. Increases with age; Prevalence 6 -10% in > 65 yrs Incidence lower in women but longer life expectancy makes prevalence equal.

ETIOLOGY

PATHOGENESIS Pathogenesis of heart failure with a depressed ejection fraction

Activation of neurohormonal systems in heart failure

CLINICAL MANIFESTATIONS Symptoms � Dyspnea � Orthopnea � PND � Cheyne-stokes respiration � Other symptoms Anorexia, nausea, early satiety, abdominal pain Confusion, disorientation, sleep and mood disturbances Nocturia

Examination � Sinus tachycardia � JVP � Abdominojugular reflux � Edema � Pulmonary crackles � Cardiac examination Displaced apex beat S 3/S 4 Murmurs of MR/TR � Tender hepatomegaly

DIAGNOSIS ECG CXR Assesment of LV function � Echocardiography � MRI � Nuclear imaging Biomarkers � BNP � Cardiac troponins Exercise Testing

TREATMENT: HEART FAILURE Activity Diet Drugs � Diuretics � ACE Inhibitors � Beta-Blockers � Aldosterone Antagonists � Digoxin � Anticoagulation and antiplatelet therapy

TREATMENT: HEART FAILURE Mechanical therapies � Cardiac resynchronization therapy (CRT)/Implantable Cardioverter Defibrillator (ICD) � Left-ventricular Assist device (LVAD) Surgical Therapies � Cardiac transplantation � LV reconstruction