HEART FAILURE

KAVINAN(+6281322812467)

Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump
enough blood through to meet the body's needs for blood and oxygen. Basically, the heart
can't keep up with its workload.

Heart tries to make up for this by:

Enlarging. When heart chamber enlarges, it stretches more and can contract more strongly,
so it pumps more blood. With an enlarged heart, body starts to retain fluid, lungs get
congested with fluid and heart begins to beat irregularly.

Developing more muscle mass. The increase in muscle mass occurs because the contracting
cells of the heart get bigger. This lets the heart pump more strongly, at least initially.

Pumping faster. This helps to increase the heart's output.

TYPES OF HEART FAILURE

Left-sided heart failure

The left ventricle supplies most of the heart's pumping power, so it's larger than the other
chambers and essential for normal function. In left-sided or left ventricular (LV) heart failure,
the left side of the heart must work harder to pump the same amount of blood.

There are two types of left-sided heart failure.

Systolic failure: The left ventricle loses its ability to contract normally. The heart can't pump
with enough force to push enough blood into circulation.

Diastolic failure (also called diastolic dysfunction): The left ventricle loses its ability to relax
normally (because the muscle has become stiff). The heart can't properly fill with blood
during the resting period between each beat.

Right-sided heart failure

Right-sided or right ventricular (RV) heart failure usually occurs as a result of left-sided
failure. When the left ventricle fails, increased fluid pressure is, in effect, transferred back
through the lungs, ultimately damaging the heart's right side. When the right side loses
pumping power, blood backs up in the body's veins. This usually causes swelling or
congestion in the legs, ankles and swelling within the abdomen such as the GI tract and liver
(causing ascites).
CLASSIFICATIONS

Class Patient Symptoms

No limitation of physical activity. Ordinary physical activity does not

I
cause undue fatigue, palpitation, dyspnea (shortness of breath).

Slight limitation of physical activity. Comfortable at rest. Ordinary

II physical activity results in fatigue, palpitation, dyspnea (shortness of
breath).

Marked limitation of physical activity. Comfortable at rest. Less than

III
ordinary activity causes fatigue, palpitation, or dyspnea.

Unable to carry on any physical activity without discomfort. Symptoms of

IV heart failure at rest. If any physical activity is undertaken, discomfort
increases.

SIGNS & SYMPTOMS

Exertional dyspnea and/or dyspnea at rest Orthopnea

Acute pulmonary edema Chest pain/pressure and palpitations

Tachycardia Fatigue and weakness

Nocturia and oliguria Anorexia weight loss, nausea

Exophthalmos and/or visible pulsation of eyes Distention of neck veins

Weak, rapid, and thready pulse Rales, wheezing

S 3 gallop and/or pulsus alternans Increased intensity of P 2 heart

sound

Hepatojugular reflux Ascites, hepatomegaly

DIAGNOSIS
The Framingham criteria for the diagnosis of heart failure consists of the concurrent presence
of either 2 major criteria or 1 major and 2 minor criteria.

Major criteria include the following:

Paroxysmal nocturnal dyspnea

Weight loss of 4.5 kg in 5 days in response to treatment
Neck vein distention
Rales
Acute pulmonary edema
Hepatojugular reflux
S 3 gallop
Central venous pressure greater than 16 cm water
Circulation time of 25 seconds
Radiographic cardiomegaly
Pulmonary edema, visceral congestion, or cardiomegaly at autopsy
Central or peripheral cyanosis, pallor

Minor criteria are as follows:

Nocturnal cough
Dyspnea on ordinary exertion
A decrease in vital capacity by one third the maximal value recorded
Pleural effusion
Tachycardia (rate of 120 bpm)
Bilateral ankle edema

Radiographic features
 Cardiomegaly

Pulmonary edema

Cardiac-Thoracic Ratio:

A+B
T1+T2
A
Normal ratio B
= 0.5

T1 T2

Signs of pulmonary edema:

CEPHALIZATION KERLEY B LINES

BATWING APPEARANCE