HEART FAILURE

A N A T O MY O F H E A R T
 ANATOMY
OF HEART

 Your heart is the muscular pump

which powers your body. It
supplies blood carrying oxygen
and nutrients to every cell, nerve,
muscle and vital organ in your
body.
 It sits in your chest between your
lungs, slightly to the left of center,
and is protected by your rib cage.
 Your heart is about the size of
your clenched fist and weighs
about 300 grams.
 WHAT ARE THE
PARTS OF THE
HEART?

Your heart is a bit like a house. It

has:
 outer walls (the outer muscle
or myocardium)
 rooms (chambers )
 doors (valve )
 plumbing (arteries and veins)
 electric (the electrical
conduction system).
 Your heart is made up of four
chambers, two on the right and
two on the left. These are like the
rooms of your house.
 The top two chambers are called
the left and right atrium and the
bottom two are called the left and
right ventricles.
 They are divided by a thin wall
called the septum

‫ ؟‬septum‫ليش ينقسمون بـ‬

 HEART VALVES
(THE DOORS
BETWEEN THE
ROOMS)

 There are four heart valves which

act like doors between the
chambers of the heart. They open
and close as your heart pumps.
 The valves only open one way(why)
? This stops blood flowing in the
wrong direction between the
chambers of your heart
The tricuspid valve is the The mitral valve is the
door between the right door between the left
atrium and ventricle. atrium and ventricle.

The other two valves are

The aortic valve is the
the doors out of the
door out of the left
ventricles. They are called
ventricle into the aorta.
semilunar, or SL valves.

The atrioventricular
The pulmonary valve is valves are those that
the door out of the right connect the atrium to the
ventrical into the ventricles and include the
pulmonary artery. mitral valve as well as the
tricuspid valve
 Blood travels between the heart and the
lungs and the rest of the body, via a
network of pipes called the blood vessels.
There are three main types of blood
vessels.
 Arteries, which carry oxygenated blood
from your heart to the rest of your
body, except Pulmonary artery.
 Veins, which carry the de-oxygenated
blood back to your heart and
lungs, except Pulmonary vein.
 Capillaries, the small vessels where
oxygenated and de-oxygenated blood is
exchanged
 THE HEART'S
CONDUCTION SYSTEM
(THE ELECTRICS)

 Your heart has its own electrical wiring system (conduction system), which keeps it
beating. This conduction system includes:

 The sinoatrial (SA) node (or sinus node). This is your body’s own internal pacemaker,
that produces electrical signals to make your heart beat

 The atrioventricular (AV) node. This is a node that passes on the electrical signals
from the upper chambers of the heart ( artia) to the lower ones (ventricles)

 The bundle of His, the left and right bundle branches, and the Purkinje fibres. These
act like electrical wiring that communicate the signals around the heart.

 The SA node sends an electrical signal that makes the upper chambers of the heart
(atria) contract (squeeze). This pushes blood out of the atria and into the lower
chambers of the heart (ventricles).

 The electrical signal passes from the atria to the AV node. From there, it passes
through the bundle of His and into the right and left bundle branches.

 Finally, the signal travels down the Purkinje fibres, causing the ventricles to contract.
This pushes blood out of your heart to your lungs and the rest of your body
 HOW THE HEART
PUMPS?

 Your conduction system sends the electrical

signals which trigger the heart to pump blood
around the body, and to and from the lungs.

 Blood which has used all its oxygen is returned

to the right side of the heart, via large veins
called the inferior and superior vena cava. From
there it is pumped to the lungs, via the
pulmonary artery.

 Once the blood has received oxygen from the

lungs, it travels through the pulmonary veins
into the left side of the heart. From here it is
pumped back out around the body, via the
aorta
 The heart has its own network of blood
vessels, which supply it with the blood it
needs to keep pumping.
 These vessels are called the coronary
arteries. They branch off the body’s largest
artery, the aorta, and lie on the outside of
your heart.

 Narrowing in one of the coronary arteries can

lead to angina and a blockage can cause a
heart attack
HEART FAILURE
 Heart failure means that the heart is unable to pump blood around
the body properly. It usually happens because the heart has become
too weak or stiff.
 It's sometimes called congestive heart failure, although this name is
not widely used now.
 Heart failure does not mean your heart has stopped working. It means
it needs some support to help it work better.
 It can occur at any age, but is most common in older people.
 Heart failure is a long-term condition that tends to get gradually worse
over time.
 Heart failure is not the same as cardiac arrest in which blood flow
stops altogether due to failure of the heart to pump effectively.
 Heart failure (HF), also known as congestive heart failure
(CHF) and (congestive cardiac failure) (CCF).
 Heart failure is a clinically syndrome
 Not a disease
 What is the main difference between disease and
syndrome?
A disease usually has a defining cause, distinguishing
symptoms and treatments. A syndrome, on the other hand, is a
group of symptoms that might not always have a definite
cause
 Heart failure can be classified as predominantly
left ventricular (systolic or diastolic), right
ventricular or biventricular based on the location
of the deficit. Depending on the time of onset, HF
is classified as acute or chronic.
 There are another names for systolic and diastolic:
1. Systolic or heart failure with reduced ejection
fraction
2. Diastolic or heart failure with preserved ejection
fraction
 And HF is also classified as high-output failure
and low-output failure
 What's the difference between acute and chronic
conditions?
Acute illnesses generally develop suddenly and last a
short time, often only a few days or weeks. Chronic
conditions develop slowly and may worsen over an
extended period of time—months to years
❑ Classification based on stages

 The New York Heart Association (NYHA) functional classification defines four functional classes as:

 Class I: HF does not cause limitations to physical activity; ordinary physical activity does not cause symptoms.

 Class II: HF causes slight limitations to physical activity; the patients are comfortable at rest, but ordinary physical
activity results in HF symptoms.

 Class III: HF causes marked limitations of physical activity; the patients are comfortable at rest, but less than
ordinary activity causes symptoms of HF.

 Class IV: HF patients are unable to carry on any physical activity without HF symptoms or have symptoms when at
rest

❑ The American College of Cardiology/American Heart Association (ACC/AHA) staging system is defined by the
following four stages:

 Stage A: High risk of heart failure, but no structural heart disease or symptoms of heart failure;

 Stage B: Structural heart disease, but no symptoms of heart failure;

 Stage C: Structural heart disease and symptoms of heart failure;

 Stage D: Refractory heart failure requiring specialized interventions

 ‫?‪What is‬‬
‫‪Cardiac output‬‬
‫‪Ejection fraction‬‬ ‫حجم الدم الذي يضخه القلب من البطين‬ ‫‪Heart beat‬‬
‫من البطين النسبة ما بين كمية الدم التطلع‬ ‫‪ .‬األيسر أو األيمن خالل دقيقة واحدة‬ ‫هي عدد المرات التي ينبض فيها القلب خالل‬
‫إلى كمية الدم المتبقية في البطين خالل‬ ‫‪Normal OP: 5 to 6 litres of‬‬ ‫الدقيقة الواحدة‪،‬‬
‫انقباض البطين لمرة واحدة‪ ،‬ويعتبر مقياساً‬
‫‪blood every minute‬‬ ‫وتختلف عند قياسها خالل الراحة عن قياسها‬
‫لقوة ضخ القلب‬
‫‪More specific: In man-‬‬ ‫‪ .‬أثناء ممارسة الرياضة‬
‫‪Normal EJ: 50%_75%‬‬
‫‪5.6L/min| In women- 4.9L/min‬‬

‫‪Normal rangr between‬‬ ‫‪Stroke volume‬‬ ‫‪End-diastolic volume‬‬

‫‪60_100beat / min‬‬ ‫هو حجم الدم المتدفق من القلب إلى الشريان‬ ‫كمية الدم الموجودة بالبطين قبل ما القلب‬
‫‪ :‬على الرغم من بعض المصادر تكول‬ ‫األبهر خالل ضربة واحدة‬ ‫ويختلف حسابها علئ حسب الحالة يتقلص‬
‫‪70_100 beat /min‬‬ ‫‪Normal range: 75_155 cm3‬‬ ‫‪ .‬الصحية للفرد‬

‫‪Vascular resistance (systemic‬‬

‫)‪Cardiac index (CI‬‬ ‫)‪vascular resistance, SVR‬‬
‫حجم الدم الي يضخه القلب من البطين او‬ ‫‪is the resistance in the‬‬
‫االذين خالل دقيقة واحدة يتناسب مع مساحة‬ ‫‪circulatory system that is used‬‬
‫الجسم‬ ‫‪to create blood pressure, the‬‬
‫‪Normal range : 2.5-4.2L/m2.‬‬ ‫‪flow of blood and is also a‬‬
‫‪component of cardiac function‬‬
 High -output failure is an
u n common disorder
acute ch aracterized by an elevated
r es ting cardiac index of greater
th an 2.5–4.0 L /min/m2 and low

Depending on the
Heart Failure s ys temic vascular resistance

time of onset
L ow output failure is much m ore
com mon than high-output failure
chronic an d is characterized by
in sufficient forward cardiac
Depending on ou tput, particularly during times
of increased metabolic demand
the location of
In right-sided heart failure, the the deficit
heart's right ventricle is too weak
Biventricular heart
to pump enough blood to the failure: In biventricular
lungs. As blood builds up in the
heart failure, both sides
veins, fluid gets pushed out into Left-sided heart failure of the heart are affected
the tissues in the body
occurs when the heart
loses its ability to
pump blood. This
With preserved ejection fraction prevents organs from With reduced ejection fraction (HFrEF)
(HFpEF) Or diastolic receiving enough Or Systolic
In patients with HFpEF who are mostly females and oxygen. The condition the LV cavity is typically dilated, and the ratio
older adults, EF is usually more than 50%; the of LV mass/end-diastolic volume is either
volume of the left-ventricular (LV) cavity is typically can lead to
normal, but the LV wall is thickened and stiff; complications that normal or reduced. At the cellular level, both
hence, the ratio of LV mass/end-diastolic volume is cardiomyocyte diameter and the volume of
high . HFpEF is further categorized as borderline include right-sided
myofibrils are higher in HFpEF than in HFrEF
HF if the EF stays between 41% and 49% and heart failure and organ And heart doesn't pump with enough force to
improved HF if EF is more than 40% is not able to
fill properly with blood during the diastolic phase,
damage push blood throughout your body.
reducing the amount of blood pumped out to the
body
 CAUSES
 Heart failure is caused by any condition that reduces the efficiency of the heart muscle, through damage
or overloading

 Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart
disease and the most common cause of heart failure. The disease results from the buildup of fatty
deposits in the arteries, which reduces blood flow and can lead to heart attack. A heart attack occurs
suddenly when a coronary artery becomes completely blocked. Damage to your heart muscle from a
heart attack may mean that your heart can no longer pump as well as it should.

 High blood pressure. If your blood pressure is high, your heart has to work harder than it should to
circulate blood throughout your body. Over time, this extra exertion can make your heart muscle too stiff
or too weak to properly pump blood.

 Faulty heart valves. The valves of the heart keep blood flowing in the proper direction. A damaged valve —
due to a heart defect, coronary artery disease or heart infection — forces the heart to work harder, which
can weaken it over time.
 CAUSES
 Damage to the heart muscle. Heart muscle damage can have many causes, including certain diseases,
infection, heavy alcohol use, and the toxic effect of drugs, such as cocaine or some drugs used for
chemotherapy. Genetic factors also can play a role.

 Inflammation of the heart muscle (myocarditis). Myocarditis is most commonly caused by a virus, including
the COVID-19 virus, and can lead to left-sided heart failure.

 A heart problem that you're born with (congenital heart defect). If your heart and its chambers or valves
haven't formed correctly, the healthy parts of your heart have to work harder to pump blood, which may
lead to heart failure.

 Abnormal heart rhythms (arrhythmias). Abnormal heart rhythms may cause your heart to beat too fast,
creating extra work for your heart. A slow heartbeat also may lead to heart failure.

 Other diseases. Long-term diseases — such as diabetes,, an overactive or underactive thyroid, a severe
anemia, kidney disease.
 SYMPTOMS
 Heart failure signs and symptoms may include:
• Shortness of breath with activity or when lying down

• Fatigue and weakness

• Swelling in the legs, ankles and feet

• Rapid or irregular heartbeat

• Reduced ability to exercise

• Persistent cough or wheezing with white or pink blood-tinged mucus

• Swelling of the belly area (abdomen)

• Very rapid weight gain from fluid buildup

• Nausea and lack of appetite

• Difficulty concentrating or decreased alertness

• Chest pain if heart failure is caused by a heart attack

• CNS abnormal
 Different between symptoms and sign?
 Symptoms are subjective and can be perceived only by the person affected. Signs are objective findings that can
be seen or measured.

 symptoms
 ‫بيها يحس وحده المريض‬
 Signs
 ‫ويتفحصها يشوفها الدكتور‬
• When to see a doctor?
• Chest pain

• Fainting or severe weakness

• Rapid or irregular heartbeat associated with shortness of breath, chest pain or fainting

• Sudden, severe shortness of breath and coughing up white or pink, foamy mucus

• NOTE!
• Although these signs and symptoms may be due to heart failure, there are many other possible causes, including
other life-threatening heart and lung conditions.
 STATISTICS

 The overall prevalence of clinically identified heart failure is estimated to be

3–20 cases/1000 population, but rises to > 100 cases/1000 population in
those aged ⩾65 years.

 6.2 million people in united state with heart failure

 960000 people that diagnosed with

 heart failure every year

 make up 8.2%of heart abnormalities causes death

 Make up 36% of cardiovascular disease

 Biventricular heart failure: In biventricular heart failure, both sides of the

heart are affected
‫ال م ضا ع فات‬
 ‫ع وا م ل ال خ ط ر‬
‫‪.‬مجتمعة العوامل من مجموعة عن أيضا ناجما القلب فشل يكون قد ولكن القلب‪ ،‬فشل في للتسبب واحد خطر عامل وجود كفى‬

‫‪:‬يلى ما القلب بفشل اإلصابة خطر عوامل شمل‬

‫‪ .‬التاجية الشرايين مرض )‪(coronary artery‬‬

‫‪.‬القلب عضلة ضعف إلى يؤدي ما باألكسجين‪ ،‬الغني بالدم القلب إمداد من الضيقة الشرايين تحد قد‬
‫قلبية نوبة )‪(heart attack‬‬

‫‪.‬ينبغي كما الدم ضخ على قادرا يعد لم القلب أن قلبية نوبة عن الناتج القلب عضلة تلف يعني وقد ‪.‬فجأة يحدث الذي التاجية الشرايين مرض أشكال من شكل هي القلبية النوبة‬

‫القلب صمام مرض‬

‫‪.‬القلب بفشل اإلصابة خطر زيادة في طبيعية بصورة يعمل ال قلبي صمام وجود يتسبب ‪.‬‬

‫‪ .‬السكري داء‬

‫‪.‬تغييرها لك ينبغي كان إذا طبيبك واسأل ‪.‬نفسك تلقاء موصوفة أدوية أي تناول عن تتوقف فال ‪ .‬التاجية الشرايين ومرض الدم ضغط بارتفاع إصابتك خطر زيادة في السكري داء يتسبب‬

‫‪.‬الدم ضغط ارتفاع‬

‫‪.‬له ينبغي مما أكبر بجهد العمل إلى قلبك يضطر دمك‪ ،‬ضغط ارتفاع عند‬

‫‪.‬القلب ضربات انتظام عدم‬

‫‪.‬القلب بفشل واإلصابة القلب عضلة إضعاف إلى للغاية‪ ،‬وسريعة متكررة كانت إذا خاصة القلبي‪ ،‬النظم اضطرابات تؤدي أن يمكن‬

‫وظيفته أو لديهم القلب هيكل في تؤثر بمشكالت القلب بفشل المصابين األشخاص بعض يولد ‪.‬الخلقي القلب مرض‬
 ‫ع وا م ل ال خ ط ر‬
‫‪ .‬تزيد من خطر اإلصابة بفشل القلب لدى بعض األشخاص )‪(Actos‬وبيوجليتازون )‪ (Avandia‬وجد أن أدوية داء السكري روزيجليتازون ‪ .‬أدوية داء السكري‬
‫بعض ‪ .‬فإذا كنت تتناولها‪ ،‬فاستشر طبيبك إذا كنت تحتاج إلى إجراء أي تغييرات ‪ .‬ومع ذلك‪ ،‬ال تتوقف عن تناول أي من هذه األدوية من تلقاء نفسك‬

‫وهي تشمل مضادات االلتهاب غير الستيرويدية وبعض أدوية ‪.‬قد تؤدي بعض األدوية إلى اإلصابة بفشل القلب أو بمشكالت في القلب ‪ .‬بعض األدوية األخرى‬
‫التخدير وبعض األدوية المستخدمة في عالج ارتفاع ضغط الدم والسرطان وأمراض الدم وضربات القلب غير المنتظمة أو غير الطبيعية وأمراض الجهاز‬
‫‪ .‬العصبي وحاالت الصحة العقلية ومشكالت الرئة والمسالك البولية واألمراض االلتهابية والعدوى‬

‫‪ .‬يمكن أن يتسبب اإلفراط في تناول المشروبات الكحولية في إضعاف عضلة القلب وقد يؤدي إلى فشل القلب ‪ .‬تعاطي الكحوليات‬

‫يؤدي عدم القدرة على التنفس بصورة طبيعية أثناء النوم إلى انخفاض مستويات األكسجين في الدم وزيادة خطر اإلصابة بعدم انتظام ‪ .‬انقطاع النفس النومي‬
‫‪ .‬ويمكن أن تتسبب كلتا هاتين المشكلتين في إضعاف القلب ‪ .‬ضربات القلب‬

‫تزداد مخاطر اإلصابة بفشل ‪.‬السمنة ‪ .‬يزيد تعاطي التبغ من خطر اإلصابة بأمراض القلب وفشل القلب ‪ .‬إذا كنت تدخن‪ ،‬فأقلع عن التدخين ‪ .‬التدخين أو تعاطي التبغ‬
‫‪ .‬القلب بين األشخاص الذين يعانون من السمنة‬

‫‪ .‬يمكن أن تتسبب بعض أنواع العدوى الفيروسية في تلف عضلة القلب ‪.‬الفيروسات‬
 ‫ال و قا ي ة‬
‫ويمكنك التحكم في العديد من عوامل الخطر المسببة ‪ .‬اإلجراء األساسي للوقاية من فشل القلب هو تقليل عوامل الخطر‬
‫‪ .‬ألمراض القلب أو القضاء عليها من خالل إدخال تغييرات صحية على نمط الحياة وتناول األدوية التي وصفها طبيبك‬
‫تشمل‬
‫‪ :‬التغييرات التي يمكنك إجراؤها في نمط الحياة للمساعدة على الوقاية منفشل القلب ما يلي‬
‫اإلقالع عن التدخين‬
‫السيطرة على بعض الحاالت‪ ،‬مثل ارتفاع ضغط الدم وداء السكري‬
‫المحافظة على النشاط الجسدي‬
‫تناول أغذية صحية‬
‫الحفاظ على وزن صحي‬
‫‪ .‬تقليل التوتر والسيطرة عليه‬
THANK YOU FOR LISTINING