What is heart failure? This may be defined as the inability of cardiac Cutput to meet the physiological demands of the body. It can be classified in several ways: Left ventricular flue (VF: Symptoms of VE: pareaysmal noctumal dyspnoea, wheeze, nocturnal cough with pink sputum ‘caused by puimonary oedema ‘Right ventricular failure (RVF): Symptoms ‘of RVE wich is usually caused by LVF or lung disease, peripheral edema and ‘© Low output and high output heart failure. Ths i due to excessive afterload, ‘excessive preload or pump failure. See page 4 Treatment Conservative: smoking cessation advice, weight loss, promotion of heathy diet and = Medical: ‘Angiotensin converting enzyme (ACE) inhibitors. Beta-biockers: currently only two are licensed in the UX, bisopolol and canediol Candesartan: an angiotensin receptor blocker (if intolerant to ACE inhibitors). Digoxin: a cardiac glycoside. Diuretics, eg. furosemide. Spironolactone: an aldosterone receptor antagonist. ‘Surgical: heart transplantation Causes Anything that causes myocardial damage may lead to hear faire Examples include: Coronary artery disease. Hypertension. ‘Atal fibilation. Valve disease Cardiomyopathies. Infective endocardt's Anaemia. Endocrine disorders Cor puimonale: this is ight ventricular failure secondary to puimonary cisease | « Renal failure Vale dysfunction © Stoke { Classification Framingham Criteria for Congestive Heart Failure: 2 major itera or 1 major citeria and 2 minor criteria © Major criteria: PAINS. Parorysmal nocturnal dyspnoea. ‘Acute pulmonary oedema Increased hear sie, Increased central ‘venous pressure Neck vein lation 3 gallop. © Minor criteria: PAIN Preuraleusion. ‘Ankle oedema (bilateral) Anceased heart rate >120 beats/min. ‘Nocturnal cough, ‘New York Heart Association Classification for Heart Failure [No limitation of physical aciviy. I: Slight imitation of physical activity ll: Marked limitation of physical activity. IV Inability to carry out physical activity | Investigations FBC, UBEs LFTs TTs lipid profile + Bloods: BNP (brain naviretic peptide). It suggests how much the myocytes are stretched. BNP is arguably Cartioprotective sit causes Na” ion and H,0 excretion in addition to vasodlation. concentration >400 pg/ml (>116 pmol) is suggestive of heart failure. © CXR ABCDE ‘Alveolar oedema Kerey B lines. Carciomegay Dilated upper lobe vessels. pleural Efusion. '¢ ECHO: aims to identify cause and assess function ofthe hear. = EGCauses of left-sided heart failure Causes of right-sided heart failure Coronary artery disease. © Leftsided heart failure, «© Hypertension. Ischaemic injury © TWcuspid valve disease. * Portic vale disease. >) Reduced myocardial efficiency. “+ Pulmonary valve disease. Mitral valve disease "= Pulmonary vascular disease © Myocardial disease Pathophysiology of Congestive Peete) ‘Increased workload, | Cordiac output © | Contract. Activates compensatory mechanisms ‘Activation ofthe renin angiotensin aldosterone system (RAAS) causes Na* ion and H,0 retention, and peripheral vasoconstriction. This increases preload. + Activation ofthe sympathetic nervous system increases heart rate and causes peripheral vasoconstriction. This increases afterload, # T Myocyte size. Chronic activation ofthese compensatory mechanisms worsens heart failure and leads to increased cardiac damage. Remember that: 1 The cause of cardiac dilation is increased end-diastolic volume « The raised jugular venous pressure (VPs related to ight sided heart failure and fluid overload. «© Hepatomegaly i caused by congestion ofthe hepatic portal circulation,