Heart Failure Heart failure (HF) is a common clinical syndrome. Heart failure (HF) is a complex clinical syndrome that can result from any structural or functional cardiovascular disorder; It causes systemic perfusion deficiency inadequate to meet the bodys metabolic demands Causes increasing left ventricular filling pressures Heart failure (HF) is a common clinical syndrome. Heart failure (HF) is a complex clinical syndrome that can result from any structural or functional cardiovascular disorder; It causes systemic perfusion deficiency inadequate to meet the bodys metabolic demands Causes increasing left ventricular filling pressures The Incidence of Congestive Heart Failure in Type 2 Diabetes As the leading cause of hospitalization for individuals aged 65 years and older (1), congestive heart failure (CHF) is emerging as a major public health concern. The CHF problem is magnified in individuals with diabetes, in whom incidence rates are two to five times greater than those in the general population. The U.K. Prospective Diabetes Study (UKPDS) reported heart failure incidence rates of 2.311.9 per 1,000 patient-years over 10 years. CHF in diabetes is 315 times greater than the previously reported 210 cases per 1,000 subjects. As the leading cause of hospitalization for individuals aged 65 years and older (1), congestive heart failure (CHF) is emerging as a major public health concern. The CHF problem is magnified in individuals with diabetes, in whom incidence rates are two to five times greater than those in the general population. The U.K. Prospective Diabetes Study (UKPDS) reported heart failure incidence rates of 2.311.9 per 1,000 patient-years over 10 years. CHF in diabetes is 315 times greater than the previously reported 210 cases per 1,000 subjects. Diabetic Cardiomyopathy-Etiology Diabetic cardiomyopathy has been defined as ventricular dysfunction that occurs in diabetic patients independent of a recognized cause (eg, coronary heart disease, hypertension Autonomic neuropathy Abnormal epicardial vessel tone and microvascular dysfunction Abnormal glycation end product deposition may increase LV diastolic stiffness Decreased insulin availability or responsiveness can impair energy-independent transport of glucose across the cell membrane. Diabetic cardiomyopathy has been defined as ventricular dysfunction that occurs in diabetic patients independent of a recognized cause (eg, coronary heart disease, hypertension Autonomic neuropathy Abnormal epicardial vessel tone and microvascular dysfunction Abnormal glycation end product deposition may increase LV diastolic stiffness Decreased insulin availability or responsiveness can impair energy-independent transport of glucose across the cell membrane. Heart Failure (Classifications) Systolic versus diastolic Systolic- loss of contractility get dec. CO Diastolic- decreased filling or preload Left-sided versus right sided Left- lungs Right-peripheral High output- hypermetabolic state Acute versus chronic Acute- MI Chronic- cardiomyopathy Symptoms Making the diagnosis - Symptoms LVF (back pressure into pulmonary system) SOB on exertionNocturnal coughPNDOrthopnoeaWheezeLethargyReduced exercise tolerance RVF (back pressure into peripheral circulation) Ankle oedemaNausea and anorexiaFatigue and wasting Abdo pain due to hepatomegaly Increased weightCCF (failure of both ventricles) (Remember to ask about chest pain and palpitations) Making the diagnosis - Signs Cachexia and muscle wastingTachypnoeic +/- cyanosisTachycardia +/- gallop rhythmCardiomegaly and displaced apexRight ventricular heaveRaised JVPBasal creps +/- effusions +/- wheezeAnkle oedemaHepatomegalyAscites What does this show? What is present in this extremity, common to right sided HF?