Overview
Heart failure can be functionally debilitating, though proper management can have a significant positive effect on a patient's mortality risk and quality of life.
Ask About
- Diagnosis - when heart failure was diagnosed, symptoms, cause
- Severity - exercise tolerance / NYHA class, ejection fraction
- Functional impact of disease
- Management - non-pharmacologic, pharmacologic, devices
- Complications - arrhythmias, peripheral oedema, pulmonary oedema, pulmonary hypertension
Causes of Heart Failure
- Ischaemic heart disease
- Cardiomyopathy
- Myocarditis
- Pericardial disease
- Valvular disease
- Congenital heart disease
- Hypertension
Precipitants of Heart Failure
- Arrhythmias
- Infection
- Anaemia
- Myocardial infarction
- IV fluid excess
- Alcohol
- Thyrotoxicosis
- Surgery
- Pregnancy
Diagnosis
Classification
- Heart failure with reduced ejection fraction (HFrEF)
- Heart failure with preserved ejection fraction (HFpEF)
Symptoms of Heart Failure
- Fatigue
- Dyspnoea
- Orthopnoea
- Paroxysmal nocturnal dyspnoea
- Reduced exercise tolerance
- Peripheral oedema
Severity
Ask About
- Exercise tolerance - use NYHA classes
- Recent echocardiogram results - ejection fraction, regional wall motion abnormalities, valvular dysfunction
New York Heart Association Classes
- INo limitation of physical activity; ordinary physical activity does not cause symptoms
- IISlight limitation of physical activity; comfortable at rest though ordinary physical activity causes symptoms
- IIIMarked limitation of physical activity; comfortable at rest though less than ordinary activity causes symptoms
- IVUnable to carry out any physical activity without discomfort; symptoms are present at rest and increase with any physical activity
Complications
Complications of Heart Failure
- Arrhythmias - atrial fibrillation, ventricular arrhythmias
- Stroke
- Sarcopaenia
Left Heart Failure
- Pulmonary oedema
- Pulmonary hypertension
Right Heart Failure
- Ascites
- Peripheral oedema
- Cardiac cirrhosis
Management
Management Options
Non-Pharmacologic
- Cardiac rehabilitation
- Low sodium diet
- Fluid restriction
- Smoking cessation
- Weight loss
Pharmacologic
- ACE inhibitors (ACEi) - captopril, ramipril, perindopril
- Angiotensin II receptor blockers (ARBs) - candesartan, irbesartan
- Beta blockers - carvedilol, metoprolol, bisoprolol, nebivolol
- Aldosterone antagonists - spironolactone
- Loop diuretics - frusemide
- Ivabradine
- Digoxin
Devices
- Biventricular pacing
- Automatic implantable cardioverter defibrillator
Surgical Options
- Heart transplant
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