Heart Failure Treatment PDF

College of Pharmacy Fourth year. Clinical Pharmacy Cardiovascular disorders Heart Failure Introduction 1-Heart failure (HF) is a syndrome associated with signs and symptoms due to abnormalities in cardiac structure or function 2-HF may be caused by an abnormality in systolic function, diastolic func...

College of Pharmacy Fourth year. Clinical Pharmacy Cardiovascular disorders Heart Failure Introduction 1-Heart failure (HF) is a syndrome associated with signs and symptoms due to abnormalities in cardiac structure or function 2-HF may be caused by an abnormality in systolic function, diastolic function, or both. 3-HF with reduced systolic function (ie, reduced left ventricular ejection fraction, LVEF) is referred to as HF with reduced ejection fraction (HFrEF). 4-Diastolic dysfunction with normal LVEF is termed HF with preserved ejection fraction (HFpEF). Pathophysiology 1-Causes of systolic dysfunction (decreased contractility) include reduced muscle mass (eg, myocardial infarction [MI]) 2-Causes of diastolic dysfunction (restriction in ventricular filling) include increased ventricular stiffness, and ventricular hypertrophy. 3-The leading causes of HF are coronary artery disease and hypertension. 4-Decreased cardiac output (CO) results in activation of compensatory responses to maintain circulation: (A) Tachycardia and increased contractility through sympathetic nervous system activation, (B) Increased preload (through sodium and water retention) increases stroke volume, (C) vasoconstriction, and (D) ventricular hypertrophy and remodeling. 5-Although these compensatory mechanisms initially maintain cardiac function, they are responsible for the symptoms of HF and contribute to disease progression. 6-Chronic activation of the neurohormonal systems results in a cascade of events that affect the myocardium. 7-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. Primary symptoms are dyspnea (especially on exertion) and fatigue, which lead to exercise intolerance. 2-Other pulmonary symptoms include: orthopnea, paroxysmal nocturnal dyspnea (PND), tachypnea, and cough. Fluid overload can result in pulmonary congestion and peripheral edema. 1 3-Nonspecific symptoms may include fatigue, nocturia, hemoptysis, abdominal pain, anorexia, nausea, bloating, ascites, poor appetite or early satiety, and weight gain or loss. 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 Functional Classification System is intended primarily to classify symptoms according to the physician’s subjective evaluation. Functional class (FC)-I patients have no limitation of physical activity. FC-II patients have slight limitation. FC-III patients have marked limitation FC-IV patients are unable to carry on physical activity without discomfort. 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 Stage At risk for HF (No HF signs A or symptoms with No structural heart disease) Stage PreHF (No HF signs or B symptoms but with structural heart disease) Stage HF (HF signs or symptoms C with structural heart disease) Recommendation Drugs are recommended for HF prevention in select patients Drugs are recommended for HF prevention in select patients Most patients with HFrEF in stage C should receive Guideline directed medical therapy (GDMT) proven to reduce morbidity and mortality. Stage Advanced HF (persistent HF They should be considered for specialized D symptoms despite maximally interventions, including mechanical circulatory tolerated GDMT) support, continuous IV positive inotropic therapy, or cardiac transplantation Nonpharmacologic Therapy of Chronic Heart Failure 1-Interventions include restriction of fluid intake and dietary sodium intake (