chf lecture dr samir tayfour (2) consultant cardiologist-ksa-cardiac centre hail

Dr SAMIR TAYFOURCONSULTANT CARDIOLOGIST

HAIL CARIAC CENTREKSA

normal Pump failure

Causes of left ventricular failure

• Volume over load: Regurgitate valve

High output status

• Pressure overload: Systemic hypertension

Outflow obstruction

• Loss of muscles: Post MI, Chronic ischemia

Connective tissue diseases

Infection, Poisons (alcohol,cobalt,Doxorubicin)

• Restricted Filling: Pericardial diseases, Restrictive

cardiomyopathy, tachyarrhythmia

Forward Vs Backward Rt. Vs Lt. sided HF Biventricular HF Acute Vs Chronic HF Flash pulmonary edema Low Vs High output HF Systolic Vs Diastolic HF

Ventricular RemodelingVentricular remodeling after acute infarction

Ventricular remodeling in diastolic and systolic heart failure

Initial infarct Expansion of infarct(hours to days)

Global remodeling(days to months)

Normal heart Hypertrophied heart(diastolic heart failure)

Dilated heart(systolic heart failure)

Framingham Criteria for Congestive Heart FailureMajor criteria:

Paroxysmal nocturnal dyspnea Neck vein distention Rales Radiographic cardiomegaly Acute pulmonary edema S3 gallop Increased central venous pressure (>16 cm H2O at right atrium) Hepatojugular reflux Weight loss >4.5 kg in 5 days in response to treatment

Minor criteria: Bilateral ankle edema Nocturnal cough Dyspnea on ordinary exertion Hepatomegaly Pleural effusion Decrease in vital capacity by one third from maximum recorded Tachycardia (heart rate>120 beats/min.)

Class INo limitations of physical activityClass IISlight limitations of physical activityClass IIIMarked limitations of physical activityClass IVInability to carry out physical activities without discomfort and/or symptoms at rest

Class II1.68 M(35%)

Class IV240 K(5%)

Class III1.20 M(25%)

Class I1.68 M(35%)

AHA Heart and Stroke Statistical Update 2001

Stages of Heart Failure

At Risk for Heart Failure:

STAGE A High risk for developing HF

STAGE B Asymptomatic LV dysfunction

Heart Failure:

STAGE C Past or current symptoms of HF

STAGE D End-stage HF

Stages of Heart Failure

• Designed to emphasize preventability of HF

• Designed to recognize the progressive nature of LV dysfunction

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ACC/AHA HF stages1

•High risk for developing HF •No structural disease

•Structural heart disease•No HF symptoms

•Structural heart disease•Prior or current HF symptoms

•Refractory end-stage HFrequiring special interventions

1Hunt SA et al. J Am Coll Cardiol. 2001;38:2101–2113. 2Criteria Committee of the New Year Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 7th ed. Boston: Little, Brown, 1973:286.

A

B

C

D

NYHA functional classes2

Asymptomatic

Symptomatic with moderate exertion

Symptomatic with minimal exertion

Symptomatic at rest

Class I

Class II

Class IV

Class III

The Progressive Development of The Progressive Development of Cardiovascular DiseaseCardiovascular Disease

Endstage Heart DiseaseEndstage Heart Disease

Congestive Heart FailureCongestive Heart Failure

Ventricular DilationVentricular Dilation

RemodelingRemodeling

Arrhythmia & Loss of MuscleArrhythmia & Loss of Muscle

Myocardial InfarctionMyocardial Infarction

Myocardial IschemiaMyocardial Ischemia

CADCAD

AtherosclerosisAtherosclerosis

Endothelial DysfunctionEndothelial Dysfunction

Risk FactorsRisk Factors

Coronary ThrombosisCoronary Thrombosis

>65years>65years Leading cause of hospitalizationLeading cause of hospitalization

Number 1 KillerNumber 1 Killer

55 years from diagnosis years from diagnosis

only only 50%50% alive alive

Evolving paradigms of heart failure progression.

De Keulenaer G W , and Brutsaert D L Circulation 2011;123:1996-2005

Copyright © American Heart Association

Conceptual approaches to cardiac performance.

De Keulenaer G W , and Brutsaert D L Circulation 2011;123:1996-2005

Copyright © American Heart Association

The heart failure spectrum.

De Keulenaer G W , and Brutsaert D L Circulation 2011;123:1996-2005

Copyright © American Heart Association

The ventricle is a dissipative structure with emerging properties.

De Keulenaer G W , and Brutsaert D L Circulation 2011;123:1996-2005

Copyright © American Heart Association

Volume – overload

hypertrophy

Normal heart

Pressure – overload

Hypertrophy

BNP With chronic heart failure, atrial mycotes secrete increase

amounts of atrial natriuretic peptide (ANP) and brain natriuretic pepetide (BNP) in response to high atrial and ventricular filling pressures

Usually is > 400 pg/mL in patients with dyspnea due to heart failure.

•B-type BNP is secreted by the ventricles in response to

increase in ventricular pressure or volume stress

•The diagnostic accuracy of BNP increases tremendously with inclusion of patients with

HFPEF

• BNP has reported sensitivity of 91% and specificity of 82%

• BNP is developing into an exclusion test for heart failure

however role of BNP for defining prognosis and monitoring of therapy still requires more

investigation