Heart Failure PDF

CVS Problems Heart Failure Dr. Amir El-gendy Clinical Pharmacy Department College of Pharmacy Almaaqal University  Heart Failure ❖ Heart failure (HF) is a syndrome associated with signs and symptoms due to abnormalities in cardiac str...

CVS Problems Heart Failure Dr. Amir El-gendy Clinical Pharmacy Department College of Pharmacy Almaaqal University  Heart Failure ❖ Heart failure (HF) is a syndrome associated with signs and symptoms due to abnormalities in cardiac structure or function. ❖ HF may be caused by an abnormality in systolic function, diastolic function, or both. ❖ HF with reduced systolic function (i.e, reduced left ventricular ejection fraction, LVEF) is referred to as HF with reduced ejection fraction (HFrEF). ❖ Diastolic dysfunction with normal LVEF is termed HF with preserved ejection fraction (HFpEF). Clinical Pharmacy – Dr. Amir Elgendy 1 ❖Pathophysiology Causes of systolic dysfunction (decreased contractility) include reduced muscle mass (e.g., myocardial infarction [MI]) Causes of diastolic dysfunction (restriction in ventricular filling) include increased ventricular stiffness, and ventricular hypertrophy. The leading causes of HF are coronary artery disease and hypertension. Decreased cardiac output (CO) results in activation of compensatory responses to maintain circulation: ✓Tachycardia and increased contractility through sympathetic nervous system activation, ✓Increased preload (through sodium and water retention) increases stroke volume ✓Vasoconstriction ✓Ventricular hypertrophy and remodeling. Clinical Pharmacy – Dr. Amir Elgendy 2  Although these compensatory mechanisms initially maintain cardiac function, they are responsible for the symptoms of HF and contribute to disease progression. Chronic activation of the neurohormonal systems results in a cascade of events that affect the myocardium. These events lead to changes in ventricular size (left ventricular hypertrophy), shape, structure, and function known as ventricular remodeling. ❖Clinical presentation 1. Patient presentation may range from asymptomatic to cardiogenic shock. 2. Primary symptoms are dyspnea (especially on exertion) and fatigue → exercise intolerance. 3. Other pulmonary symptoms include: orthopnea, paroxysmal nocturnal dyspnea (PND), tachypnea, and cough. Fluid overload can result in pulmonary congestion and peripheral edema. 4. Nonspecific symptoms may include: fatigue, nocturia, hemoptysis, abdominal pain, anorexia, nausea, bloating, ascites, poor appetite or early satiety, and weight gain or loss Clinical Pharmacy – Dr. Amir Elgendy 3  ❖Diagnosis 1. Ventricular hypertrophy can be demonstrated on chest radiograph or electrocardiogram (ECG). Chest radiograph may also show pleural effusions or pulmonary edema. 2. Echocardiogram can quantify LVEF to determine if systolic or diastolic dysfunction is present. 3. The New York Heart Association (NYHA) Functional Classification System is intended primarily to classify symptoms according to the physician’s subjective evaluation. ✓Functional class (FC)-I (NYHA-I): Patients have no limitation of physical activity. ✓FC-II (NYHA-II): Patients have slight limitation. “Asymptomatic at rest, but symptoms of HF with normal level of activity” ✓FC-III (NYHA-III): Patients have marked limitation. “Asymptomatic at rest but symptoms of HF with less than normal level of activity” ✓FC-IV (NYHA-IV): Patients are unable to carry on physical activity without discomfort. “Symptoms of HF at rest or unable to carry out any physical activity” Clinical Pharmacy – Dr. Amir Elgendy 4 Clinical Pharmacy – Dr. Amir Elgendy 5  ❖Treatment of chronic heart failure ✓ Goals of Treatment: Improve quality of life, relieve or reduce symptoms, prevent or minimize hospitalizations, slow disease progression, and prolong survival. ❖ General Approach 1. The first step is to determine the etiology or precipitating factors. Treatment of underlying disorders (e.g., hyperthyroidism) may obviate the need for treating HF. 2. An international group developed a staging system: Stage Description Recommendation At risk for HF (No HF signs or symptoms with Drugs are recommended for HF prevention in select Stage A No structural heart disease) patients PreHF (No HF signs or symptoms but with Drugs are recommended for HF prevention in select Stage B structural heart disease) patients Most patients with HFrEF in stage C should receive HF (HF signs or symptoms with structural heart Stage C Guideline directed medical therapy (GDMT) proven to disease) reduce morbidity and mortality. They should be considered for specialized interventions, Advanced HF (persistent HF symptoms despite Stage D including mechanical circulatory support, continuous IV maximally tolerated GDMT) positive inotropic therapy, or cardiac transplantation Clinical Pharmacy – Dr. Amir Elgendy 6 ❖Treatment of chronic heart failure Nonpharmacologic Therapy of Chronic Heart Failure 1. Interventions include restriction of fluid intake and dietary sodium intake (