Heart Failure Overview

Heart Failure

• Inability of the heart to pump oxygen-rich blood to tissues and organs
• Leading reason for hospital admission in people over 65

Etiology

• Factors increasing workload or damaging vessels
  • Hypertension (HTN)
  • Coronary Artery Disease (CAD)
  • Myocardial Infarction (MI)
• Other contributing conditions
  • Diabetes Mellitus (DM)
  • Metabolic syndrome
  • Anemia
  • Genetic predisposition
  • Infections
  • Fluid retention
  • Dysrhythmias (e.g., atrial fibrillation, atrial flutter)
  • sleep apnea
  • Hyper/Hypothyroidism

Classification

• Based on severity and NYHA (New York Heart Association) functional classification scales
• Stages A-D (ascending order of severity)
• Higher stages limit activities of daily living (ADLs)

Left vs. Right Heart Failure

• Left-Sided HF*:

• Reduced ejection fraction (EF) below ~40% (normal ~55-65%)

• Blood backs up into the lungs

• Symptoms: dyspnea, cough, crackles, tachypnea, fatigue, cyanosis

• Right-Sided HF*:

• Blood backs up into the body

• Symptoms: JVD, peripheral edema, ascites, hepatosplenomegaly

Compensatory Mechanisms

• Neurohormonal Responses:
  • Renin-Angiotensin-Aldosterone System (RAAS) activation leads to fluid retention and increased blood pressure
  • Kidneys' reaction to lack of perfusion
• Ventricular Adaptations:
  • Ventricular dilation: Stretching of heart muscle to accommodate more blood (temporary solution)
  • Ventricular hypertrophy: Thickening of heart muscle (long-term, eventually harmful)

Assessment and Diagnosis

• Early Symptoms: fatigue, dyspnea, symptoms worsen with exertion or lying down
• Respiratory Symptoms: orthopnea, paroxysmal nocturnal dyspnea, chronic cough, pulmonary congestion (pink, frothy sputum)
• Circulatory Symptoms: tachycardia, palpitations, edema, dizziness, syncope, angina
• Lab tests: BNP, cardiac markers (CK-MB, troponin), electrolytes, blood counts), ECG (electrocardiogram), echocardiogram (ECHO)
• Fluid Imbalances: weight gain, edema, ascites
• Renal Symptoms: decreased urine output, nocturia

Medications

• Diuretics (fluid removal)
• Hypertension medications
• Beta-blockers, and/or other blood pressure management medications
• Anticoagulants (blood thinners) might be necessary

Other Factors

• Thyroid function: issues with thyroid can cause HF.
• Lipid panel: useful to evaluate risk of cardiovascular disease (linked to HF)

Patient Education

• Teach patients about signs of fluid overload
• Encourage adherence to medication regime
• Emphasize importance of diet and lifestyle changes
• Advise on when to call the doctor (symptoms worsening)
• Management of activities that can worsen HF