Right and Left Heart Failure - By Mr Murdin Amit

1. Lifestyles, Fitness
and Rehabilitation
Heart Failure
CCF/CHF
LVF 1st + RVF 2nd = CCF/CHF
By :
Mr Murdin b Amit
Bsc in Health Science (Hons), Ba in Buissness Administration (Hrm)(Hons)
Head of Medical Science Subject
College of Assistant Medical Officer,
Seremban, Negeri Sembilan
murdin_1966@yahoo.com
HP: 012 - 6044385

2. Lifestyles, Fitness Heart Failure
and Rehabilitation
• What is Heart Failure?
– The heart is not pumping as well as it
should
– Usually, the heart has been weakened
by an underlying condition
• Blocked arteries
• Heart attack
• High blood pressure
• Infections
• Heart valve abnormalities

3. Lifestyles, Fitness Heart Failure
and Rehabilitation
• What is Heart Failure?
– Heart failure can involve the left or right
side of the heart or both
– Usually the left side is affected first
– Heart failure occurs when either side of
the heart cannot keep up with the flow
of blood

4. Lifestyles, Fitness Heart Failure
and Rehabilitation
• What is Heart Failure?

5. Lifestyles, Fitness Heart Failure
and Rehabilitation
• What is Left Heart Failure?
– Involves the left ventricle (lower
chamber) of the heart
– Systolic failure
• The heart looses it’s ability to contract or
pump blood into the circulation
– Diastolic failure
• The heart looses it’s ability to relax because
it becomes stiff
• Heart cannot fill properly between each beat

6. Lifestyles, Fitness Heart Failure
and Rehabilitation
• What is Left Heart Failure?
– Systolic and diastolic heart failure are
treated with different types of
medications
– In both types, blood may “back up” in
the lungs causing fluid to leak into the
lungs (pulmonary edema)
– Fluid may also build up in tissues
throughout the body (edema)

7. Lifestyles, Fitness Heart Failure
and Rehabilitation
• What is Right Heart Failure?
– Usually occurs as a result of left heart
failure
– The right ventricle pumps blood to the
lungs for oxygen
– Occasionally isolated right heart failure
can occur due to lung disease or blood
clots to the lung (pulmonary embolism)

8. Lifestyles, Fitness Heart Failure
and Rehabilitation
• How fast does heart failure
develop?
– Usually a chronic disease
– The heart tries to compensate for the
loss in pumping function by:
• Developing more muscle mass
• Enlarging
• Pumping faster

9. Lifestyles, Fitness Heart Failure
and Rehabilitation
• What Causes Heart Failure?
– Health conditions that either damage
the heart or make it work too hard
• Coronary artery disease
• Heart attack
• High blood pressure
• Abnormal heart valves
• Heart muscle diseases (cardiomyopathy)
• Heart inflammation (myocarditis)

10. Lifestyles, Fitness Heart Failure
and Rehabilitation
• What Causes Heart Failure?
• Congenital heart defects
• Severe lung disease
• Diabetes
• Severe anemia
• Overactive thyroid gland (hyperthyroidism)
• Abnormal heart rhythms

11. Lifestyles, Fitness Heart Failure
and Rehabilitation
• What Causes Heart Failure?
– Coronary artery disease
• Cholesterol and fatty deposits build up in
the heart’s arteries
• Less blood and oxygen reach the heart
muscle
• This causes the heart to work harder and
occasionally damages the heart muscle

12. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• What Causes Heart Failure?
– Heart attack
• An artery supplying blood to the heart
becomes blocked
• Loss of oxygen and nutrients damages
heart muscle tissue causing it to die
• Remaining healthy heart muscle must pump
harder to keep up

13. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• What Causes Heart Failure?
– High blood pressure
• Uncontrolled high blood pressure doubles a
persons risk of developing heart failure
• Heart must pump harder to keep blood
circulating
• Over time, chamber first thickens, then gets
larger and weaker

14. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• What Causes Heart Failure?
– Abnormal heart valves
– Heart muscle disease
• Damage to heart muscle due to drugs,
alcohol or infections
– Congenital heart disease
– Severe lung disease

15. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• What Causes Heart Failure?
– Diabetes
• Tend to have other conditions that make the
heart work harder
• Obesity
• Hypertension
• High cholesterol

16. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• What Causes Heart Failure?
– Severe anemia
• Not enough red blood cells to carry oxygen
• Heart beats faster and can become overtaxed with
the effort
– Hyperthyroidism
• Body metabolism is increased and overworks the
heart
– Abnormal Heart Rhythm
• If the heart beats too fast, too slow or irregular it may
not be able to pump enough blood to the body

17. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• Signs and Symptoms of Heart Failure
– Shortness of Breath (dyspnea)
• WHY?
– Blood “backs up” in the pulmonary veins
because the heart can’t keep up with the supply
an fluid leaks into the lungs
• SYMPTOMS
– Dyspnea on exertion or at rest
– Difficulty breathing when lying flat
– Waking up short of breath

18. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• Signs and Symptoms of Heart Failure
– Persistent Cough or Wheezing
• WHY?
– Fluid “backs up” in the lungs
• SYMPTOMS
– Coughing that produces white or pink blood-
tinged sputum (Froty Sputum)

19. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• Signs and Symptoms of Heart Failure
– Edema
• WHY?
– Decreased blood flow out of the weak heart
– Blood returning to the heart from the veins
“backs up” causing fluid to build up in tissues
• SYMPTOMS
– Swelling in feet, ankles, legs or abdomen
– Weight gain

20. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• Signs and Symptoms of Heart Failure
– Tiredness, fatigue
• WHY?
– Heart can’t pump enough blood to meet needs of
bodies tissues
– Body diverts blood away from less vital organs
(muscles in limbs) and sends it to the heart and
brain
• SYMPTOMS
– Constant tired feeling
– Difficulty with everyday activities

21. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• Signs and Symptoms of Heart Failure
– Lack of appetite/ Nausea
• WHY?
– The digestive system receives less blood
causing problems with digestion
– Physiological disturbance to Vagus nerve
• SYMPTOMS
– Feeling of being full or sick to your stomach

22. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• Signs and Symptoms of Heart Failure
– Confusion/ Impaired thinking
• WHY?
– Changing levels of substances in the blood
( sodium) can cause confusion
– Lack of O2 reach to the brain
• SYMPTOMS
– Memory loss or feeling of disorientation
– Relative or caregiver may notice this first

23. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• Signs and Symptoms of Heart Failure
– Increased heart rate
• WHY?
– The heart beats faster to “make up for” the loss
in pumping function
• SYMPTOMS
– Heart palpitations
– May feel like the heart is racing or throbbing

24. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• New York Heart Association (NYHA)
Functional Classification
Class % of patients Symptoms
I 35% No symptoms or limitations in ordinary
physical activity
II 35% Mild symptoms and slight limitation
during ordinary activity
III 25% Marked limitation in activity even during
minimal activity. Comfortable only at
rest
IV 5% Severe limitation. Experiences
symptoms even at rest

25. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• Treatment Options
– The more common forms of heart failure
cannot be cured, but can be treated
• Lifestyle changes
• Medications
• Surgery

26. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• Lifestyle changes
– Stop smoking
– Loose weight
– Avoid alcohol
– Avoid or limit caffeine
– Eat a low-fat, low-sodium diet
– Exercise

27. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• Lifestyle changes
– Reduce stress
– Keep track of symptoms and weight and
report any changes or concern to the
doctor
– Limit fluid intake
– See the doctor more frequently

28. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• Medications used to treat Heart
Failure
– ACE Inhibitors (Enalapril 5-10mg bd/tds)
• Cornerstone of heart failure therapy
• Proven to slow the progression of heart
failure
• Vasodilator – cause blood vessels to
expand lowering blood pressure and the
hearts work load

29. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• Medications used to treat Heart Failure
– Diuretics (water pills) – Frusemide 40-80mg
• Prescribed for fluid build up, swelling or edema
• Cause kidneys to remove more sodium and
water from the bloodstream
• Decreases workload of the heart and edema
• Fine balance – removing too much fluid can
strain kidneys or cause low blood pressure

30. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• Medications used to treat Heart
Failure
– Potassium
• Most diuretics remove potassium from the
body
• Potassium pills compensate for the amount
lost in the urine
• Potassium helps control heart rhythm and
is essential for the normal work of the
nervous system and muscles

31. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• Medications used to treat Heart Failure
– Vasodilators
• Hydrallazine 100mg stat or Prazosin 1-2mg bd/tds
• Cause blood vessel walls to relax
• Occasionally used if patient cannot tolerate ACE
• Decrease workload of the heart

32. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• Medications used to treat Heart Failure
– Digitalis preparations
• Digoxin 0.25mg-0.5mg bd
• Increases the force of the hearts contractions,
increases the blood stroke volume
• Relieves symptoms
• Slows heart rate and certain irregular heart beats

33. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• Medications used to treat Heart Failure
– Beta-blockers (Tab Metoprolol 50-200mg)
• Lower the heart rate and blood pressure
• Decrease the workload of the heart
– Blood-thinners (coumadin)
• Used in patients at risk for developing blood clots
in the blood vessels, legs, lung and heart
• Used in irregular heart rhythms due to risk of
stroke

34. Heart Failure
Lifestyles, Fitness
and Rehabilitation
• Treatment options
– Surgery and other Medical Procedures
• Not often used in heart failure unless there
is a correctable problem
• Coronary artery bypass
• Angioplasty
• Valve replacement
• Defibrillator implantation
• Heart transplantation
• Left ventricular assist device (LVAD)