Heart Failure

Dr. Birhanu Fiseha

(General Doctor of Medicine, Lecturer)
@ Arsi University
College of Health Sciences
Heart Failure

 A constellation of
signs/symptoms that
result from the inability
of the heart to pump
blood to the body at a
rate the body needs.
 Assess Risk Factors/Causes of
HF
 Coronary artery  Arrhythmia
disease
 Anemia
 Angina/infarction
 Fluid volume overload
with non-cardiac causes
 Chronic hypertension
 Thyroid disease
 Idiopathic dilated
cardiomyopathy  Renal disease

 Valvular heart disease  Medications (e.g.

 Obesity / tobacco Cancer chemotherapy)
smoking
 HF--- types

 Look for signs and

symptoms

 Diagnostic test
results

 Document the
findings
 Myocardial Dysfunction
Systolic Dysfunction Diastolic
 Decreased left
 Left ventricle has ventricular filling
reduced muscle  Caused by
contractility ventricular
stiffness,
decreased rate of
relaxation, or
rapid heart rate
 Functional Assessment (NYHA Functional
classification)

 Class I  Class III

 No limitations of  Symptoms with minimal
physical activity. No exertion. SOB, fatigue,
shortness of breath, heart palpitations.
fatigue, or heart Patients comfortable at
palpitations with rest.
ordinary physical
activity.  Class IV
 Severe to complete
limitation of activity.
 Class II SOB, fatigue, heart
 Slight limitation of palpitations, even at
physical activity. SOB, rest.
fatigue, heart
palpitations. Patient
comfortable at rest.
 American College of Cardiology
American Heart Association

 Stage A High risk of HF, no structural

heart abnormality

 Stage B Structural heart disorder, no

symptoms

 Stage C Structural disorder, past or

current HF symptoms

 Stage D End-stage disease, requiring

specialized treatment
 What are the symptoms of heart failure?

 Shortness of breath or trouble

breathing.
 Feeling tired (fatigue) and leg
weakness when you are active.
 Swelling in your ankles, legs and
abdomen.
 Need to urinate while resting at night.
 Dizziness
 Rapid or irregular heartbeats
(palpitations)
 A dry, hacking cough.
 What’s in a work-up?

 History/exam

 Lab tests

 Chest x-ray

 EKG

 All look for reversible

causes of CHF
 Treatment of HF
 Heart failure treatment:
 Treatment of risk factors

 Treatment of underlying causes

 Treatment of precipitating factors

 Treatment of congestion if any

 Rehabilitation
Goals of Rx

 Prolong life

 Prevent worsening

 Improve quality of
life

 Provide comfort care

 Treat contributing factors and underlying causes of
heart failure
Like what??
 Arrhythmia  Unstable angina

 Pulmonary embolism  Fluid volume status

 Accelerated/malignant  Renal failure

hypertension
 Medication-induced
 Thyroid disease
 High salt-intake
 Valvular heart disease
 Severe anemia
 Other relevant interventions
 Dietary counseling

 Diet modification

 Exercise

 Smoking cessation

 Address end-stage HF
 Monitoring of Rx

 Complications in an
effort to “treat”
heart failure can
occur.