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Heart Failure: Definition

Heart Failure: Definition.

neil-richardson
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Heart Failure: Definition

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  1. Heart Failure: Definition A clinical syndrome that occurs in patients who, because of an inherited or acquired abnormality of cardiac structure or function, develop a constellation of clinical symptoms (dyspnea, fatigue) and signs (edema, rales), that lead to frequent hospitalizations, a poor quality of life, and a shortened life expectancy.

  2. Heart Failure:A Progressive Disease, a Growing Burden 5 million Americans (2%) have HF Yearly incidence >500,000 cases/year 80% HF admissions are older than 65 1 million hospitalizations/year 5-10% of all admissions Most frequent reason for hospitalization in elderly 3000+ HF admissions in Maine 284,365 deaths in 2004 (28% increase over decade) More than lung, breast, prostate cancer and HIV/AIDS combined

  3. Heart Failure:Risk Factors • Male gender • Older age • Physical inactivity • Obesity • Diabetes • Hypertension • Valvular heart disease • Cigarette smoking

  4. Heart Failure:Etiologies • CAD 51% • Idiopathic 13% • Undetermined 10% • Valve 10% • Hypertension 6.4% • Other 5% • Alcohol 4% • Atrial Fibrillation 3% • Fox KF, Cowie MR, Wood DA, et al. Coronary artery disease as the cause of incident heart failure in the population. Eur Heart J. 2001;22:228-236.

  5. Heart Failure: Pathophysiology Volume overload Elevated left ventricular diastolic pressure Edema, jugular venous distension Dyspnea, hypoxia Elevated pulmonary arterial, venous pressure Renal salt, water retention

  6. Braunwald

  7. DIASTOLIC DYSFUNCTION

  8. Heart Failure: Cardinal Symptoms • Dyspnea • Orthopnea • Edema • Cough • Liver engorgement

  9. Heart Failure: Cardinal Signs • Tachycardia • Tachypnea • Hypoxia • Edema • Venous distension • Rales • Signs of pleural effusion (R>L) • Cardiac enlargement • Presystolic (S4) or protodiastolic (S3) gallop • Murmur? • Hepatomegaly/HJR

  10. Heart Failure: Diagnosis • PE: signs of volume overload, LV dysfunction, valve disease • Imaging: 2DEcho with Doppler flow studies; CXR (?); ECG • Lab: CBC, chemistries, LFTs, TFTs, BNP (?) • Coronary angiography

  11. Heart Failure: Differential Diagnosis • Infection • Neoplasm • Pulmonary embolism • Nephrotic syndrome • Venous insufficiency

  12. Heart Failure Classification • A: At risk but asymptomatic, with no apparent structural abnormality (CAD, DM, ethanol use, family history…) • B: Asymptomatic but with cardiac structural abnormality (HTN/LVH, prior MI, valve disease) • C: Structural abnormality and symptoms • D: End stage, refractory HF

  13. Heart Failure: Therapy • Stage A: • Control risk factors, treat underlying chronic disease contributors • Stage B: • ACE/ARB/BB if appropriate • Stage C: • ACE?ARB, BB, diuretics • Other vasodilators as appropriate • Devices (bi-V pacing, Implantable defibrillators • Stage D: • Mechanical assist devices • Continuous infusion of inotropics • Heart transplant • Hospice • Experimental surgery or drugs

  14. Heart Failure: Prognosis 1950 - 2000 Framingham Heart Study

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