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ByDr Tharwat Wagdy Hussien

Ass.Prof.of Hematology & InternalMedicine

Medical Academy

By

Dr Tharwat Wagdy Hussien

Ass.Prof.of Hematology & InternalMedicine

Medical Academy

Heart Failure

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What is Heart Failure? The heart is not pumping as well as it

should

Usually, the heart has been weakened byan underlying condition

Blocked arteries

Heart attack

High blood pressure Infections

Heart valve abnormalities

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Heart failure can involve the left

or right side of the heart or both

Usually the left side is affectedfirst

Heart failure occurs when either

side of the heart cannot keep upwith the flow of blood.

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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 eachbeat

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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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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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What Causes Heart Failure? Health conditions that either damage

the heart or make it work too hard:

1-Coronary artery disease 2-Heart attack

3-High blood pressure

4-Abnormal heart valves 5-Heart muscle diseases

(cardiomyopathy)

6-Heart inflammation (myocarditis)

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7- Congenital heart defects

8- Severe lung disease

9- Diabetes 10-Severe anemia

11-Overactive thyroid gland

(hyperthyroidism) 12-Abnormal heart rhythms

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1-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 harderand occasionally damages the heart

muscle

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2-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

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3-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

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4-Abnormal heart valves

5-Heart muscle disease

Damage to heart muscle due todrugs, alcohol or infections

6-Congenital heart disease

7-Severe lung disease

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8-Diabetes

Tend to have other conditions thatmake the heart work harder

9-Obesity

Hypertension High cholesterol

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10-Severe anemia Not enough red blood cells to carry oxygen

Heart beats faster and can become overtaxedwith the effort

11-Hyperthyroidism Body metabolism is increased and overworks

the heart

12-Abnormal Heart Rhythm If the heart beats too fast, too slow or

irregular it may not be able to pump enoughblood to the body

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Signs and Symptoms of Heart Failure 1- Shortness of Breath (dyspnea)

WHY?

Blood backs up in the pulmonary veins because theheart 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

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2-Persistent Cough or Wheezing

WHY?

Fluid backs up in the lungs

SYMPTOMS

Coughing that produces white or pink blood-tinged

sputum

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3-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

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4-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

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5- 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

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6- 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

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7- 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

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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

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Treatment Options

The more common forms of heart failurecannot be cured, but can be treated

Lifestyle changes

Medications

Surgery

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I- Lifestyle changes 1- Stop smoking

2- Loose weight

3- Avoid alcohol

4- Avoid or limit caffeine

5- Eat a low-fat, low-sodium diet

6- Exercise

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7- Reduce stress

8- Keep track of symptoms and weight

and report any changes or concern tothe doctor

9- Limit fluid intake

10-See the doctor more frequently

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II- Medications used to treat Heart

Failure: 1-ACE Inhibitors

Cornerstone of heart failure therapy

Proven to slow the progression of heart

failure Vasodilatorcause blood vessels to expand

lowering blood pressure and the hearts work

load

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2- 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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3- 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 nervoussystem and muscles

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4- Vasodilators

Cause blood vessel walls to relax

Occasionally used if patient cannottolerate ACE

Decrease workload of the heart

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5- Digitalis preparations

Increases the force of the hearts

contractions Relieves symptoms

Slows heart rate and certain irregular

heart beats

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6- Beta-blockers Lower the heart rate and blood pressure

Decrease the workload of the heart

7- Anticoagulant (coumadin) Used in patients at risk for developing blood

clots in the blood vessels, legs, lung andheart

Used in irregular heart rhythms due to risk ofstroke

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III- 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)

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