What is heart failure?
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
2 Heart failure with reduced ejection fraction ( systolic Heart failure)
symptoms and signs
Excersional dyspnea orthopnea dry irritating caugh , paroxysmal nocturnal dyspnea, epigastric pain , abdominal distension, nocturea
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
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
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
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
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.