HEART FAILURE

Definition

A clinical picture resulting from

decreased cardiac performance with
cardiac output lower in comparison
with peripheral necessities.

Etiology

Cardiomyopathies (primary
myocardial disease )
Ischemic heart disease
Haemodynamic overload
Arrhythmias
In fact any severe heart disease is
possible to evolute towards heart
failure syndrome

Pathology

myocardial cells
performance of existing myocites

Pathophysiology

systolic performance (LV, RV or both)

diastolic performance (LV, RV or both)
forward heart failure ( cardiac output)
backward heart failure (congestive
syndrome)
left side heart failure
right side heart failure
chronic heart failure
acute heart failure

Pathogenesis
Adaptation mechanisms I
Hypertrophy
Dilatation
heart rate (tachycardia)
contractility (notfunctionning)

Adaptation mechanisms II

peripheral A +V O2 extraction
Redistribution of cardiac output
peripheral vasoconstriction
blood volume and of venous return
( Na and H2O retention)

Realised through:

Cathecolamines
RAA system

The proposed explanation for the Starling effect, whereby a greater

end-diastolic fiber length develops a greater force.

Signs and symptoms

Signs and symptoms

Heart:
- sinus tachycardia
- ventricular gallop (S3)
- regurgitation systolic murmur:
- mitral regurgitation
- tricuspid regurgitation
2. exercise capacity
1.

Congestive syndrom

Lungs: - dyspnea,
- rales,
- dullness,
- pleural effusion
Liver:
- hepathomegaly
- tenderness
Peripheral edema
Ascites, pleural effusion, pericardial effusion
(rare)
Venous distention : jugular hepatojugular reflux
Cyanosis: - peripheral
- central

Low output syndrom

Weakness, fatigue
Pallor
weight
Oliguria
SBP DBP
Cerebral symptoms

Investigations

Echocardiography
- LV, RV or both
- contractility
- LA, RA or both
- LVEF, RVEF or both
- PAPs
- MR, TR
- diastolic LV dysfunction:
- abnormal relaxation
- pseudonormalisation
- restriction

Rx (chest x ray)

cardiac chambers
Cardiothoracic ratio >0,55
Pulmonary congestion
Pulmonary arterial hypertension
Pleural effusion

ECG
- always abnormal
Morphologycal abnormalities
- of the underlying disease
- necrosis
- hypertrophy
- arrhythmias:
- atrial fibrillation
- ventricular: PVB, VT,
- sinus tachycardia

Exercise stress testing

To establish the exercise capacity

(METS) and NYHA class (also
possible an a clinical basis)

Rare investigations

Cardiac angiography
Coronarography
Myocardial biopsy
MRI
CT multislice

Biochemical date

BNP, ANP
Lipids
Liver function tets
Glycemia
Ions: Na, K
Creatinine
Haematocrit

TREATMENT

TREATMENT

TREATMENT

ulmonary Edem

 Pulmonary

edema is a condition
characterized by fluid accumulation in the
lungs caused by back pressure in the lung
veins. This results from malfunctioning of
the heart.

 Pulmonary

edema is a complication of a
myocardial infarction (heart attack), mitral
or aortic valve disease, cardiomyopathy, or
other disorders characterized by cardiac
dysfunction.

PRECIPITANTS AND CAUSES OF ACUTE HEART FAILURE

 Fluid

backs up into the veins of the lungs.

Increased pressure in these veins forces
fluid out of the vein and into the air spaces
(alveoli). This interferes with the exchange
of oxygen and carbon dioxide in the
alveoli.

 Extreme

shortness of breath, severe

difficult breathing
Feeling of "air hunger" or "drowning"
"Grunting" sounds with breathing
Inability to lie down
Rales
Wheezing
Anxiety

 Restlessness
Cough
Excessive
Pale

sweating

skin
Nasal flaring
Coughing up blood
Breathing, absent temporarily

 Listening

to the chest with a stethoscope

(auscultation) may show crackles in the
lungs or abnormal heart sounds.
A chest x-ray may show fluid in the lung
space.
An echocardiogram may be performed in
addition to (or instead of) a chest x-ray.

 Blood

oxygen levels (low)

A chest X-ray may reveal the following:
Fluid in or around the lung space
Enlarged heart

 An

ultrasound of the heart

(echocardiogram) may reveal the
following:
Weak heart muscle
Leaking or narrow heart valves
Fluid surrounding the heart

INTRAVENOUS VASODILATORS USED TO TREAT ACUTE

HEART FAILURE