Lifestyles, Fitness and Rehabilitation

Heart Failure

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Heart Failure

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

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Heart Failure

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

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Heart Failure
What is Heart Failure?

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Heart Failure

What is Left Heart Failure?

Involves the left ventricle (lower chamber) of the heart Systolic failure
The heart looses its ability to contract or pump blood into the circulation

Diastolic failure
The heart looses its ability to relax because it becomes stiff Heart cannot fill properly between each beat

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Heart Failure

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)

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Heart Failure

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)

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Heart Failure

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

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Heart Failure

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)

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Heart Failure

What Causes Heart Failure?

Congenital heart defects Severe lung disease Diabetes Severe anemia Overactive thyroid gland (hyperthyroidism) Abnormal heart rhythms

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Heart Failure

What Causes Heart Failure?

Coronary artery disease
Cholesterol and fatty deposits build up in the hearts arteries Less blood and oxygen reach the heart muscle This causes the heart to work harder and occasionally damages the heart muscle

Heart Failure
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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

Heart Failure
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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

Heart Failure
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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

Heart Failure
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What Causes Heart Failure?

Diabetes
Tend to have other conditions that make the heart work harder Obesity Hypertension High cholesterol

Heart Failure
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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

Heart Failure
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Signs and Symptoms of Heart Failure

Shortness of Breath (dyspnea)
WHY?
Blood backs up in the pulmonary veins because the heart cant 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

Heart Failure
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Signs and Symptoms of Heart Failure

Persistent Cough or Wheezing
WHY?
Fluid backs up in the lungs

SYMPTOMS
Coughing that produces white or pink bloodtinged sputum

Heart Failure
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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

Heart Failure
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Signs and Symptoms of Heart Failure

Tiredness, fatigue
WHY?
Heart cant 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

Heart Failure
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Signs and Symptoms of Heart Failure

Lack of appetite/ Nausea
WHY?
The digestive system receives less blood causing problems with digestion

SYMPTOMS
Feeling of being full or sick to your stomach

Heart Failure
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Signs and Symptoms of Heart Failure

Confusion/ Impaired thinking
WHY?
Changing levels of substances in the blood ( sodium) can cause confusion

SYMPTOMS
Memory loss or feeling of disorientation Relative or caregiver may notice this first

Heart Failure
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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

Heart Failure
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New York Heart Association (NYHA) Functional Classification

% of Symptoms patients
35% 35% 25% 5% No symptoms or limitations in ordinary physical activity Mild symptoms and slight limitation during ordinary activity Marked limitation in activity even during minimal activity. Comfortable only at rest Severe limitation. Experiences symptoms even at rest

Class
I II III IV

Heart Failure
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Treatment Options
The more common forms of heart failure cannot be cured, but can be treated
Lifestyle changes Medications Surgery

Heart Failure
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Lifestyle changes
Stop smoking Loose weight Avoid alcohol Avoid or limit caffeine Eat a low-fat, low-sodium diet Exercise

Heart Failure
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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

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Medications used to treat Heart Failure

ACE Inhibitors
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

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Medications used to treat Heart Failure

Diuretics (water pills)
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

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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

Heart Failure
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Medications used to treat Heart Failure

Vasodilators
Cause blood vessel walls to relax Occasionally used if patient cannot tolerate ACE Decrease workload of the heart

Heart Failure
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Medications used to treat Heart Failure

Digitalis preparations
Increases the force of the hearts contractions Relieves symptoms Slows heart rate and certain irregular heart beats

Heart Failure
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Medications used to treat Heart Failure

Beta-blockers
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

Heart Failure
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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)