2. DEFINITION
Clinical syndrome that develops when the heart cannot
maintain adequate cardiac output, or can do so only at
the expense of elevated ventricular filling pressures
AHA
Complex clinical syndrome that results from structural or functional
impairment of ventricular filling or ejection of blood, which in turn leads
to the cardinal clinical symptoms of dyspnea and fatigue and signs of HF,
namely edema and rales.
3. EPIDEMIOLOGY
64.34 Mn
Current world wide prevalence
2%
Age > 65
6-10%
Developed countries
No 1
1in 5
Every Individual Life time risk
of developing Heart Failure
Cause of Hospitalization
25%
Rehospitalisation rate within 1
months of discharge
5. ETIOLOGY
HF WITH REDUCED EF ( <40%)
CAD
•Myocardial ischaemia
•Myocardial infarction
Chronic pressure overload
• Hypertension,
•Obstructive valvular disease
Chronic volume overload
•Regurgitant valvular disease
•Intra and extra cardiac shunt
Chronic lung disease
•Cor pulmonale,
•Pulmonary vascular disorders
Non ischaemic DCM
•Familial / genetic, infiltration disorders
•Toxic / drug induced - Metabolic, viral
Disorders of rate and rhythm
•Chronic bradyarrhthmias
•Chronic tachyyarrhthmias
HF WITH PRESERVED EF ( >40%)
Pathologic hypertrophy
•Primary (HCM),
•Secondary (Hypertension)
Aging
Restrictive cardiomyopathy
•Infiltrative disorders (amyloidosis, sarcoidosis),
•Storage disorders (Hemochromatosis)
Fibrosis
Endomyocardial disorders
HIGH OUTPUT HEART FAILURE
Metabolic disorders
• Thyrotoxicosis
Nutritional disorders (Beriberi)
Excessive blood flow requirements
•Systemic AV shunting,
•chronic anaemia
6. RIGHT SIDED HEART FAILURE
Cor Pulmonale
Tricuspid & Pulmonary Valve diseases
Carcinoid syndrome
Constrictive Pericarditis
RV endomyocardial Fibrosis
ARVD
Most common cause left heart Failure
Predominant right heart failure occur in some conditions
7. PATHOPHYSIOLOGY
Cardiac Output determined by 3 factors
Preload Afterload
Myocardial
Contractility
Depressed contractility is the primary factor mostly in heart
failure with reduced EF
11. CLINICAL FEATURES
Chronic Heart Failure – A relapsing remitting course
With intermittent worsening episodes of systemic &
pulmonary congestion
Acute Heart Failure can be de novo or decompensation
of chronic heart failure
Clinical features caused by
Low Cardiac output
Elevated LV & LA pressures – pulmonary Venous Congestion
Elevated RV & RA pressures – systemic Venous Congestion
25. BIO MARKERS
BNP & NT pro BNP – markers of myocardial stretch
Useful in Diagnosis & Prognosis
Differentiate from Non cardiac causes of breathlessness &
edema
35. NON PHARMACOLOGICAL
TREATMENT
DEVICE THERAPY
Cardiac Resynchronization
therapy
Implantable cardioverter
defibrillator
Ventricular Assist devices – short
term & Long term
INTERVENTION & SURGERY
PCI
CABG
Valve surgeries
LV reconstruction surgeries
Cardiac transplantation
36. CRT
• Cardiac Resynchronisation
theapy for HFrEF
• LBBB with wide QRS > 120,
• Non LBBB > 150
• Ensures simultaneous
contraction of different
segments of heart
ICD
• Implantable cardioverter
defibrillator- to prevent death
from lethal arrythmias
• HFrEF, HCM
38. PCI or CABG
• Post MI Heart Failure
• Ischemic Cardiomyopathy
heart failure
•
CARDIAC TRANSPLNTATION
• Only definitive treatment in
Advanced heart Failure