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Heart Failure
Khalid F AlHabib.MBBS.FRCPC
Cardiology Consultant
King Fahad Cardiac Centre
King Saud University
Friday, April 1, 2016
Heart Failure: Outline
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Definition
Causes
Epidemiology
Pathophysiology
Clinical Assessment
Management
Prognosis
Heart Failure: Definition
 Complex syndrome in which abnormal
heart function results in, or increases the
subsequent risk of, clinical symptoms and
signs of low cardiac output &/or pulmonary
or systemic congestion.
CAUSES & FORMS
Systolic versus Diastolic HF
PREVALENCE & COST
Heart Failure: a major public health problem
The number of CHF patients will almost double
between the years 1990-2030, from these 3 million
cases of overt CHF to about 6 million.
Prevalence of HF
Increases with Age
10
Population (%)
Males
8
Females
6
4
2
0
20–24
25–34
35–44
45–54
55–64
Age (yr)
US, 1988–1994
AHA. Heart Disease and Stroke Statistics—2004 Update
65–74
75+
Estimated Direct and Indirect Costs of HF in US
Hospitalization
$13.6
Total Cost
$25.8 billion
53%
14%
Nursing Home
$3.5
7%
8%
8%
10%
Physicians/Other
Professionals
$1.8
Drugs/Other
Home Healthcare Medical Durables
$2.1
$2.7
Lost Productivity/
Mortality*
$2.1
*Lost future earnings of persons who will die in 2004, discounted by 3%
AHA. Heart Disease and Stroke Statistics—2004 Update
PATHOPHYSIOLOGY
CLINICAL EVALUATION
ACUTE VS. CHRONIC HEART FAILURE
FEATURE
ACUTE HEART FAILURE
DECOMPENSATED CHRONIC HEART
FAILURE
CHRONIC HEART
FAILURE
Symptom severity
Marked
Marked
Mild to moderate
Pulmonary edema
Frequent
Frequent
Rare
Peripheral edema
Rare
Frequent
Frequent
Weight gain
None to mild
Frequent
Frequent
Whole-body fluid volume load
No change or mild increase
Moderate to marked increase
Mild to marked increase
Cardiomegaly
Uncommon
Usual*
Common*
Ventricular systolic function
Reduced, normal, or
hypercontractile
Reduced*
Reduced*
Wall stress
Elevated
Markedly elevated
Elevated
Activation of sympathetic nervous system
Marked
Marked
Mild to marked
Activation of renin-angiotensin-aldosterone
system
Often increased
Marked
Mild to marked
Reparable, reversible causative lesion(s)
Common
Occasional
Occasional
*Patients with diastolic heart failure may have little to no cardiomegaly and normal systolic function.
Clinical and pathophysiological characteristics of the two major categories of unstable heart failure (acute heart failure and decompensated chronic heart failure) are compared
with those of chronic heart failure.
Adapted from Leier CV: Unstable heart failure. In Colucci WS (ed): Heart Failure: Cardiac Function and Dysfunction. 2nd ed. In Braunwald E (series ed): Atlas of Heart Diseases,
vol 4. Philadelphia, Current Medicine, 1999, pp 9.1–9.17.
A, Pulmonary blood flow redistribution. Enlargement of the upper lobe vessels is seen in a patient with ischemic
cardiomyopathy and elevated pulmonary venous pressure. B, Pulmonary interstitial edema. The vessels are indistinct
and enlarged, and peribronchial cuffing is present. C, Pulmonary alveolar edema in a patient with congestive
cardiomyopathy. The central perihilar distribution of edema, termed “bat wing” edema, is typical of pulmonary alveolar
edema caused by cardiovascular or fluid overload (uremic). D, Preferential right upper lobe distribution of pulmonary
edema in a 65-year-old man with mitral regurgitation. E, Right pleural effusion and residual right upper and bilateral
lower lobe edema in a patient with acute mitral regurgitation.
MANAGEMENT
PROGNOSIS
Causes of Hospital Readmission for
Congestive Heart Failure
Over 2/3 of HF Hospitalizations Preventable
Diet Noncompliance
24%
16%
Inappropriate Rx
Rx Noncompliance
24%
19%
Failure to Seek
Care
Annals of Internal Medicine 122:415-21, 1995
17%
Other
Overall
5-year mortality 50%
Survival %
Prognosis with Heart Failure: More “Malignant” Than Cancer !
100
90
80
70
60
50
40
30
20
10
0
Women
Men
0
1
2
3
4
5
6
7
8
9
10
Years
Survival after the onset of congestive heart failure in Framingham Heart Study subjects
AHA, 1998 Heart and Statistical Update
NCHS, National Center for Health Statistics
Ho Circulation 1993;88:107-115
In Summary..