HEART FAILURE A A PUMP IN DISTRESS Dr

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HEART FAILURE: A A PUMP IN DISTRESS Dr Tom Mabin Vergelegen Mediclinic Somerset West

HEART FAILURE: A A PUMP IN DISTRESS Dr Tom Mabin Vergelegen Mediclinic Somerset West Cardiac Support group September 2016

“ die hart is net ‘n pomp” 1968

“ die hart is net ‘n pomp” 1968

Causes of heart failure § § § § § Poorly controlled hypertension(high blood pressure)

Causes of heart failure § § § § § Poorly controlled hypertension(high blood pressure) Myocardial infarctions(heart attacks) Uncontrolled Irregular heart rhythms(arrhythmias) Leaking heart valves Blocked heart valves Infections. . viral toxins: /medications eg alcohol/chemotherapy Congenital Unknown(cardiomyopathy)

Heart failure: the size of the problem § § § >10% of patients >70

Heart failure: the size of the problem § § § >10% of patients >70 years have HF Commonest cause of hospitalisation in >70 years Increasing frequency: ageing population; more survivors of myocardial infarction Most have high BP and /or heart attack history Diagnosis often missed: treatment delayed

Symptoms of heart failure § § § Fatigue/tiredness/lack of energy Shortness of breath Inability

Symptoms of heart failure § § § Fatigue/tiredness/lack of energy Shortness of breath Inability to lie flat in bed at night(orthopnea) Swelling of legs/abdomen Blue extremities

Diagnosis of heart failure History § History… CAUSES: § ü ü ü ü High

Diagnosis of heart failure History § History… CAUSES: § ü ü ü ü High blood pressure Heart attacks/angina Heart murmurs / valves Heart surgery Flu-like illnesses Toxins/chemotherapy CLINICAL EXAMINATION……….

Examination in heart failure § § § Breathless Fast pulse BP § § §

Examination in heart failure § § § Breathless Fast pulse BP § § § fluid accumulation Neck veins elevated Ankle swelling (oedema) Lung congestion(crackles) Murmurs Abdominal swelling

Diagnosis of heart failure § ECG ü ü ü § Arrythmia Heart attacks Heart

Diagnosis of heart failure § ECG ü ü ü § Arrythmia Heart attacks Heart enlargement Echocardiogram Heart size Heart function. . left ventricular performance (ejection fraction) ü Valve leaks and/or blockages ü ü § Angiogram ü Coronary artery disease/ heart attckes

chambers and valves Ultrasound or sonar

chambers and valves Ultrasound or sonar

Management of heart failure § LIFESTYLE CHANGES: Restrict fluid intake: 1. 5 Li/day: daily

Management of heart failure § LIFESTYLE CHANGES: Restrict fluid intake: 1. 5 Li/day: daily weighing ü Reduce salt intake ü Quit alcohol / cigarettes ü Reduce weight ü Regular moderate excercise ü

§ Management of heart failure Treat the cause: üHigh BP üCoronary disease: Stents/bypass üArrhythmia

§ Management of heart failure Treat the cause: üHigh BP üCoronary disease: Stents/bypass üArrhythmia üAttend to the valve lesion if appropriate eg surgery

Management of heart failure § Treat the symptoms Diuretics: remove the water § Ace

Management of heart failure § Treat the symptoms Diuretics: remove the water § Ace inhibitors: assist the heart § Beta-blockers: assist the heart; slow the pulse § Specialised medications §

The Donkey Analogy Heart failure limits a patient's ability to perform the routine activities

The Donkey Analogy Heart failure limits a patient's ability to perform the routine activities of daily living…

Diuretics Reduce the number of sacks on the wagon eg: lasix: puresis: spiractin

Diuretics Reduce the number of sacks on the wagon eg: lasix: puresis: spiractin

ACE inhibitors Reduce the number of sacks on the wagon eg: prexum; pearinda; zartan;

ACE inhibitors Reduce the number of sacks on the wagon eg: prexum; pearinda; zartan;

ß-Blockers Limit the donkey’s speed, thus saving energy Dilatrend; Carloc; Bilocor

ß-Blockers Limit the donkey’s speed, thus saving energy Dilatrend; Carloc; Bilocor

Take your pills!

Take your pills!

Management of heart failure § Specialised devices üPacemakers üArtificial mechanical hearts üHeart transplant

Management of heart failure § Specialised devices üPacemakers üArtificial mechanical hearts üHeart transplant

� Postero-lateral

� Postero-lateral

LVAD: artificial heart

LVAD: artificial heart

Pacemakers(CRT) and mechanical heart(LVAD) Increase the donkey’s (heart) efficiency

Pacemakers(CRT) and mechanical heart(LVAD) Increase the donkey’s (heart) efficiency

“ die hart is net ‘n pomp” 1968……. . 2016

“ die hart is net ‘n pomp” 1968……. . 2016