What is heart failure?

Heart failure is a medical condition where the heart does not work as efficiently as it should. This means that your blood can’t deliver enough oxygen and nourishment to organs to  work normally. This can cause various symptoms such as fatigue become tired and breathless in  walking and work ing and a build up of fluid in your lungs and other parts of your body, such as your legs and abdomen.

Heart failure often develops because of another medical condition, such as coronary artery disease,  high blood pressure, anemia and severe obstructive sleep apnoea.

Although it is called heart ‘failure’, this doesn’t mean that your heart is about to stop working. It does mean that your heart is having difficulty working to meet the needs of your body, especially during activity.

Types of heart failure

1 Heart  failure with reserved ejection fraction ( systolic Heart  failure)

2 Heart  failure with reduced ejection fraction ( systolic Heart  failure)

symptoms and signs

Elevated JVP, third heart sound , laterally displaced apical pulse , fluid retention.

Excersional dyspnea orthopnea dry irritating caugh , paroxysmal nocturnal dyspnea, epigastric pain , abdominal distension, nocturea

Work up

Check ECG for left bundle branch block , first degree atrioventricular block, Left anterior hemi block, non specific atrioventricular conduction delay.Other abnormalities left ventricular hypertropy , evidence of Q wave in patients with coronary heart disease. sinus trachicardia , atrial fibrillation

X  ray changes for heart size , cardiac chamber enlargement ,interstitial or alveolar edema, pulmonary congestion , valvular or pericardial calcification,  co-exciting  thoracic disease

Echocardiogram for confirmation of heart failure , cardiac structure and function, severity , ejection fraction . in addition full blood examination, electrolites kidney function, liver function , lipid profile and blood sugar.In addition coronary angiography, holter monitoring, HIV, Hemocromatosis studies , amilodosis rheumatological diseases.

Grading the severity of heart failure

 NYHA functional classification

1  No limitation of physical activity

2 slight limitation of physical activity

3 Marked limitation of physical activity

4 Unable to carry out any physical activity with out symptoms or symptoms at rest

causes for heart failure

Common causes  – coronary artery disease , hypertension , diebetes   Less common – Non ischemic idiopathic dilated cardiomyopathy       Rare causes – Alcohol cardiomyopathy, viral cardiomyopathy,Thyroid dysfunction , chronic arrhythmia

Risk factors for cardiac failure – coronary artery disease , low physical activity , smoking ,overweight , hypertension , diabetes , valvular heart disease , Left ventricular hypertrophy , atrial fibrillation , obstructive sleep apnoea, family history of dilated cardiomyopathy

deferential diagnosis

Pneumonia, COPD, Pulmonary fibrosis, Anemia , cirrhosis , renal failure, pulmonary embolism

minimum investigations should include an ecocardiogram , elecrocardiogram, chest X ray , plasma electrolites and full blood count thyroid function and brain natruietic peptides

management of hear failure

Risk factor management – Blood pressure , diabetes, anemia, heart disease management is the primary management strategy.

Start ACEI and betablocker initially and next step of heart failure management is minaralocorticoid receptor antagonist.when it is symptomatic with optimal treatment the next step is to replace ACEI by angiotensine receptor neprilycine inhibitor. Diuretics ,digoxin, ivabradine,intravenous iron infusion are involved in the management process.

Lifestyle modification , graduated exercise plan, quit smoking, avoid alcohol, dietary management are the key factors in the management process. Multidisciplinary approach  including cardiology referral , exercise physiologist, dietitian , psychologist , physiotherapist and other health professionals cardiovascular rehabilitation program are help full to achieve the management goals.

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