DIAGNOSIS AND

MANAGEMENT OF HEART
FAILURE

Waleed Zahoor
Roll no. 300
Final year MBBS
 Heart Failure is a clinical syndrome that develops when the heart
can not maintain adequate output or can only do so at the expense of
elevated ventricular filling pressure.

 Heart failure in clinical practice may be diagnosed when a patient

with significant heart failure develops the signs or symptoms of low
cardiac output, pulmonory congestion or systemic venous congestion.
 MECHANISMS OF HEART
FAILURE

 Reduced ventricular contractility

 Ventricular outflow/inflow obstruction

 Ventricular volume overload

 Arrhythmia

 Diastolic Dysfunction
 TYPES OF HEART FAILURE

 Left sided heart failure

 Right sided heart failure

 Biventricular heart failure

 Another important classification is:

Acute Heart Failure

Chronic Heart Failure

 COMPLICATIONS

 Renal Failure
 Hypokalemia
 Hyperkalemia
 Hyponatremia
 Impaired liver function
 Thromboembolism
 Atrial and Ventricular Arrhythmias
 CLINICAL ASSESSMENT

 Acute Heart Failure: Sudden onset of dyspnea at rest progressing to

respiratory distress, orthopnea, agitation, pale and clammy skin, cool
peripheries, rapid pulse, JVP elevated, Gallop rhythm with a third heart
sound, Crepitations at lung bases due to pulmonory edema

 Chronic Heart Failure: Relapsing and remitting course, fatigue,

crepitations, oliguria, uremia, elevated JVP, marked weight loss, skeletal
muscle atrophy.
 INVESTIGATIONS

1. Echocardiography

2. Chest X-ray

3. Other investigations (Serum Urea, Creatinine, Electrolytes,

Hemoglobin, Thyroid Function, ECG)

4. Brain Natriuretic Peptide (Marker of Risk)

 MANAGEMENT

 General Measures

 Drug Therapy
 GENERAL MEASURES

 Education, counselling

 Diet: Weight reductions and restricted salt.

 Alcohol avoidance

 Smoking cessation

 Regular exercise
 DRUG THERAPY

 Diuretic Therapy

 ACE Inhibitor Therapy

 ARBs

 Vasodilator Therapy

 Beta Blockers

 Other Drugs(Ivabradine, Digoxin, Amiodarone)

 DIURETICS

 Increase in urinary sodium, and water excretion leading to

reduction in blood and plasma volume.

 Reduces preload and afterload.

 Decreases mortality and morbidity

 Loop and Thiazide used usually

 ACE INHIBITORS AND ARB

 Interrupts vicious cycle of neurohumoral activation.

 Decreases morbidity and mortality

 VASODILATORS

 Venodilators eg nitrates reduce preload

 Arterial dilators eg hydralazine reduce afterload.

 Limited use due to tolerance and hypotension

 BETA BLOCKERS

 Reduces risk of arrhytmias and sudden death

 Small incremental doses increase ejection fraction, improve

symptoms, reduce mortality and morbidity.
 OTHER TREATMENTS

 Implantable cardiac defibrillators and resynchronization therapy

 Coronory revascularization (Coronory artery bypass surgery or

percutaneous coronory intervention)

 Heart Transplantation

 Ventricular Assist Devices (LVAD)

THANK YOU