Heart Failure
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Overview
HF is a complex clinical
Abnormality of cardiac
syndrome that results
structure or function
from any structural/
leading to failure of heart
functional impairment of
to deliver O2 required for
ventricular filling/ blood
metabolizing tissues1
ejection
HF with reduced EF
Cardinal manifestation:
(HFrEF) & preserved EF
dyspnea & fatigue
(HFpEF)2
1. McMurray JJV, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012.
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Epidemiology
Absolute mortality
rates for HF remain Incidence in USA is
approximately 50% approximately 2-
within 5 years of 5/1,000 per year
diagnosis1
1. Yancy CW, et al. 2013 ACCF/AHA Heart Failure Guideline. Circulation. 2013;128:000–000.
2. Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart ailure. Nat Rev. Cardiol. 2011; 8; P 30-41.
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Risk Factors
Hypertension
• Especially elevated diastolic pressure (isolated hypertension)
• The incidence of HF is greater with higher levels of blood
pressure, older age & longer duration of hypertension
Diabetes mellitus
• Obesity & insulin resistance are important risk factors
Metabolic syndrome
• Abdominal adiposity, hypertriglyceridemia, low high-density
lipoprotein, hypertension, and fasting hyperglycemia
• Prevalence of metabolic syndrome at age < 20 exceeds 20%
and 40% at age > 40
Atherosclerotic disease
• Coronary, cerebral, or peripheral blood vessels1
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1. Yancy CW, et al. 2013 ACCF/AHA Heart Failure Guideline. Circulation. 2013;128:000–000.
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Cardiac Structural Abnormalities &
Other Causes of HF
Dilated cardiomyopathies
•Ventricular dilation & depressed myocardial contractility
Familial cardiomyopathies
Toxic cardiomyopathy
•Alcohol, cocaine, cancer therapies (anthracycline)
Tachycardia-induced cardiomyopathy
Inflammation-induced cardiomyopathy
•Hypersensitivity myocarditis, rheumatological/ connective tissue disorders myocardial fibrosis
1. Yancy CW, et al. 2013 ACCF/AHA Heart Failure Guideline. Circulation. 2013;128:000–000.
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History & Physical Examination
History
Potential etiology, duration of illness, severity &
trigger of dyspnea & fatigue, presence of chest
pain, development of peripheral edema or
ascites, diet & medication
Physical
Examination BMI or evidence of weight loss, blood pressure
(pulse pressure may reflect cardiac output), JVP
(congestion), extra heart sounds & murmurs (S3
is associated with adverse prognosis in HFrEF;
murmurs – valvular disease), right ventricular
heave (pulmonary hypertension), hepatomegaly,
ascites, peripheral edema, temperature of lower
extremities (inadequate cardiac output)
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1. Yancy CW, et al. 2013 ACCF/AHA Heart Failure Guideline. Circulation. 2013;128:000–000.
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Classification
Classification EF (%) Description
1. Yancy CW, et al. 2013 ACCF/AHA Heart Failure Guideline. Circulation. 2013;128:000–000.
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Diagnosis
Diagnosis of HFrEF
1. Symptoms typical of HF
2. Signs typical of HF
3. Reduced LVEF
Diagnosis of HFpEF
1. Symptoms of typical of HF
2. Signs typical of HF
1. McMurray JJV, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European
Journal of Heart Failure. 2012; 14; P 803-869
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1. McMurray JJV, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European
Journal of Heart Failure. 2012; 14; P 803-869
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Stages of Heart Failure
ACCF/ AHA Stages of HF NYHA Functional Classification
A At high risk for HF but None
without structural heart
disease or symptoms of HF
B Structural heart disease but I No limitation of physical activity
without signs or symptoms
of HF
C Structural heart disease with
prior or current symptoms
II Slight limitation of physical activity,
of HF
comfortable at rest, but ordinary
physical activity results in symptoms of
HF
III Marked limitation of physical
activity. Comfortable at rest, but less
than ordinary activity causes
symptoms of HF.
D Refractory HF requiring IV Unable to carry on any physical
specialized interventions activity, without symptoms of HF, or
symptoms of HF at rest.
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1. Yancy CW, et al. 2013 ACCF/AHA Heart Failure Guideline. Circulation. 2013;128:000–000.
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Prognosis
1. McMurray JJV, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European
Journal of Heart Failure. 2012; 14; P 803-869
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Conclusion
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