Heart Failure Overview

The percentage of blood ejected from the left ventricle during each heartbeat, relative to the amount of blood in the ventricle at the end of filling.

A complex condition where the heart cannot pump blood effectively to meet the body's metabolic needs. It arises from structural or functional heart problems.

Refers to the heart's ability to contract forcefully. It is influenced by factors like the nervous system and circulating hormones.

The amount of blood pumped out of the left ventricle with each heartbeat.

The amount of blood in the ventricle at the end of the relaxation phase (diastolic filling) before the next contraction.

The volume of blood pumped out of the heart per minute.

A group of hormones, including angiotensin II and aldosterone, that are activated by the body to regulate blood pressure and fluid balance. These hormones play a role in heart failure by constricting blood vessels and retaining water, leading to increased workload on the heart.

A condition where the heart muscle thickens and stiffens, reducing its ability to fill with blood. It is a natural response to heart failure, but long-term hypertrophy can worsen the condition.

Heart failure with reduced ejection fraction; a type of heart failure where the heart's ability to pump blood is significantly weakened.

Heart failure with preserved ejection fraction; a type of heart failure where the heart muscle is stiff and cannot fill with blood properly.

A group of medications that block the harmful effects of hormones released by the body in response to heart failure.

Medications that act on the renin-angiotensin system to reduce blood pressure and improve heart function.

Medications that help to lower blood pressure and reduce fluid retention in the body.

A medication that can help to improve heart contractility and increase cardiac output.

A medication that blocks the effects of aldosterone, a hormone that can worsen heart failure.

These medications reduce the angiotensin II-mediated increase in sympathetic discharge and aldosterone, leading to decreased cardiac workload.

They inhibit cardiac extracellular matrix and collagen deposition and have been shown to decrease mortality in patients with a reduced ejection fraction (EF) of 35% or less.

These medications should not be given to patients whose creatinine clearance is less than 30 ml/min or serum creatinine is greater than 2.5 mg/dL in men or 2 mg/dl in women.

They slow or reverse catecholamine-induced ventricular remodeling, reduce myocyte death from catecholamine induced necrosis or apoptosis, improve ejection fraction, reduce hospitalizations and decrease all-cause mortality in patients with systolic heart failure.

Bisoprolol, Metoprolol Succinate and Carvedilol are commonly used in heart failure management.

Add Beta-Blockers to an existing ACE inhibitor therapy at a low dose when HF symptoms are stable and patients are euvolemic (proper fluid balance).

Diuretics are essential when prescribing Beta-Blockers in patients with current or recent history of fluid retention because they help prevent fluid overload.

These medications should be used in low doses and titrated up to target doses over several weeks depending on tolerability of adverse effects and blood pressure.

Diuretics are medications that decrease plasma volume, reducing venous return to the heart (preload) and lowering cardiac workload. They can also reduce afterload by decreasing blood pressure.

Loop diuretics are the preferred choice for managing volume overload in heart failure due to their effectiveness even in patients with poor kidney function.

Loop diuretics should be initiated at low doses and gradually increased to achieve a weight loss of 0.5 to 1 kg per day, aiming for a balanced fluid level.

When a patient reaches a balanced fluid level, diuretics can be carefully reduced and eventually stopped in suitable cases.

Positive inotropic agents increase the force of heart muscle contractions, improving blood flow to the body.

Digoxin is a cardiac glycoside used for patients with heart failure who remain symptomatic despite standard treatment.

Digoxin increases the force of heart contractions, improving cardiac output. It also reduces heart rate by increasing vagal activity and decreasing sympathetic activity.

Digoxin is typically reserved for patients with heart failure with reduced ejection fraction who remain symptomatic despite standard treatment.

Digoxin is a medication used to treat certain types of heart failure, atrial arrhythmias, and atrial fibrillation.

Digoxin is not recommended for diastolic heart failure, a type of heart failure where the heart muscle is stiff.

Digoxin has a narrow therapeutic index, which means the difference between an effective dose and a toxic dose is small. Monitoring plasma digoxin concentration is crucial.

Common adverse effects include arrhythmias, gastrointestinal issues like nausea and vomiting, neurological symptoms like fatigue and confusion, and vision problems like blurred vision and yellow haloes.

Electrolyte disturbances like hypokalemia can increase the risk of digoxin toxicity. Drugs that inhibit digoxin excretion or metabolism can also contribute to toxicity.

Digoxin toxicity can be treated by stopping the drug, administrating potassium, and using digoxin immune Fab (Digibind) to neutralize the drug.

Digoxin should be used cautiously with other drugs that slow AV conduction, including β-blockers, verapamil, and diltiazem, as they can increase the risk of heart block.

β-Adrenergic agonists, such as dobutamine and dopamine, are used for short-term treatment of acute heart failure and cardiogenic shock. They improve cardiac performance and vasodilate.

Dobutamine, a commonly used inotropic agent for heart failure, increases cardiac contractility. This means it helps the heart beat stronger, improving blood flow. It's often used for patients with heart failure.

Milrinone is a phosphodiesterase inhibitor used to treat acute heart failure. It increases cardiac contractility and has a strong vasodilating effect, helping the heart relax and pump more efficiently.

Long-term use of Milrinone can lead to side effects such as thrombocytopenia (low platelet count), ventricular arrhythmias (irregular heartbeats), and increased mortality in patients with severe heart failure. It is therefore primarily used for short-term management.

Vasodilators, such as hydralazine and nitrates, are used in heart failure management. They help to lower afterload (resistance the heart faces when pumping blood) and preload (amount of blood returning to the heart). This reduces the workload on the heart, improving its efficiency.

Hydralazine and isosorbide dinitrate are often combined for heart failure treatment, especially in patients who cannot tolerate ACE inhibitors. Hydralazine dilates arteries, reducing afterload, while isosorbide dinitrate dilates veins, reducing preload.

Ivabradine, an 'If' channel blocker, selectively slows heart rate without affecting the force of contraction. This increases stroke volume and improves heart function in patients with heart failure with reduced ejection fraction.

Ivabradine is particularly helpful in patients with heart failure with reduced ejection fraction (HFrEF) as it reduces the workload on the heart by lowering the heart rate. This leads to increased stroke volume and improved symptoms. It can also be used if the patient has an abnormally slow heart rate (bradycardia) or slow conduction through the heart (AV block).

This medication works by blocking the If channel, which is involved in regulating the heart rate. This selective inhibition of the If channel leads to slowed heart rate without impacting the strength of the heart's contraction. This can be helpful for patients with heart failure, as it allows their heart to pump more efficiently.