CHAPTER I INTRODUCTON

CHAPTER II LITERATURE STUDY

DEFINITION
EPIDEMIOLOGY
ETIOLOGY
PATHOPHYSIOLOGY
SIGN AND SYMPTOM
ADVANCE EXAMINATION
MANAGEMENT AND THERAPY

CHAPTER III CASE REPORT

CHAPTER IV DISCUSSION
CHAPTER V CONCLUSION

CHAPTER I INTRODUCTON
CHAPTER II LITERATURE STUDY

DEFINITION
EPIDEMIOLOGY
ETIOLOGY
PATHOPHYSIOLOGY
SIGN AND SYMPTOM
ADVANCE EXAMINATION
MANAGEMENT AND THERAPY

CHAPTER III CASE REPORT

CHAPTER IV DISCUSSION
CHAPTER V CONCLUSION

DEFINITION
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

Douglas et al, 2001

 HF is a complex clinical syndrome that

results from any structural or
functional impairment of ventricular
filling or ejection of blood.

2013 ACCF/AHA Guideline for the Management of Heart Failure

Epidemiology
5 hospitals in Java and Bali island1687 patients
with ADHF were admitted at the emergency room
Mean age was 60 years, 64.5% male.
Compared to other countries (Asia Pasific, Europe,
US), Indonesian patients were sicker, had more
severe symptoms, lower ejection fraction, as well
as higher in-hospital mortality (6.7%).

ADHERE, 2006

Etiology
Systolic failure- most common cause
Hallmark finding: Dec. in *left ventricular
ejection fraction (EF)
Due to
Impaired contractile function (e.g., MI)
Increased afterload (e.g., hypertension)
Cardiomyopathy
Mechanical abnormalities (e.g., valve
disease)

Etiology
Diastolic failure
Impaired ability of ventricles to relax
and fill during diastole > dec. stroke
volume and CO
Diagnosis based on presence of
pulmonary congestion,
pulmonary hypertension, ventricular
hypertrophy
*normal ejection fraction (EF)-

Etiology
Mixed systolic and diastolic failure
Seen in disease states such as dilated
cardiomyopathy (DCM)
Poor EFs (<35%)
High pulmonary pressures

Biventricular failure (both ventricles

may be dilated and have poor filling
and emptying capacity)

Risk Factors for Heart Failure

Coronary artery
disease

Hypertension (LVH) Diabetes

Congenital heart defects
Valvular heart
Other:
disease
Obesity
Alcoholism
Age
Infection (viral)

Smoking
High or low hematocrit lev
Obstructive Sleep Apnea

CAD=coronary artery disease; LVH=left ventricular hypertrophy.

Pathologic Progression of CV Disease

Sudden
Death

Coronary
artery disease
Hypertension
Diabetes

Myocardial
injury

Pathologic
remodeling

Low ejection
fraction

Cardiomyopat
hy
Valvular
disease

Death

Pum
p
failur
e

Neurohormon
al
stimulation
Myocardial
toxicity
Adapted from Cohn JN. N Engl J Med. 1996;335:490498.

Symptoms:
Dyspnea
Fatigue
Edema

Chronic
heart
failure

Compensatory Mechanisms:

Renin-Angiotensin-Aldosterone System
Beta
Stimulation
CO
Na+

Renin + Angiotensinogen
Angiotensin I
ACE
Angiotensin II

Peripheral
Vasoconstrictio
n

Kaliuresis

Aldosterone Secretion

Fibrosis

Salt & Water Retention

Plasma Volume

Afterload
Cardiac Output

Heart Failure

Preload
Cardiac Workload

Edema

Reference
1. AHA. 2013 .Guideline for the Management of Heart Failure:
Executive Summary A Report of the American College of
Cardiology Foundation/American Heart Association Task
Force on Practice Guidelines
2. Douglas L, Douglas P, Zipes, Peter L, Robert O, Bonow.
2001. Braunwald's Heart Disease: A Textbook of
Cardiovascular Medicine, Single Volume, 8e (Heart Disease
(Braunwald) (Single Vol))8th Edition. Elsevier Saunders
3. Jay N. Cohn. 1996. The Management of Chronic Heart
Failure. N Engl J Med 1996; 335:490-498