Is when the heart has difficulty keeping up with the needs of the body

Typically seen in patients over the age of 65

There are 4 areas that affect the function of the heart

1.    Contractile state of myocardium
2.    Pre-load of ventricle
3.    The Afterload of the ventricle
4.    The heart rate

When the heart decreases in function it is typically associated with one of the four factors.

The functionality of the pump can be associated with several contributing factors.

The heart itself in some cases can become enlarged

Heart failure may be Right sided or Left sided or eventually BOTH.

Left sided heart failure

•   Low cardiac output
•   Elevated pulmonary venous pressure
•   Dyspnea is a common symptom

Right sided heart failure

•   Fluid retention is common
•   Ascites Ascites
•   Hepatic cogestion
•   Can be caused by left ventricle failure

Causes
•      Mycoardial Infarction
•      Ishcemic cardiomyopathy
•      Coronary Artery Disease
•      Systemic Hypertension
•      Rheumatic Heart Disease
•      Alcohol
•      Viral Myocarditis
•      Bacteria
•      Dilated Cardiomyopathies
•      Drug toxicity
•      Valvular heart diseases

Symptoms
   -    Cough
   -    Shortness of breath
   -    Edema
   -    Enlarged heart
 

ECG may show and underlying arrhythmia
Chest X-ray will show the shape and size of heart
Echocardiogram helps with diagnosis
Ultrasound may be helpful
Radionuclide angiography helps analyze pressure

Functional Classification is done by New York Heart Association Functional Classification

Class I:    No limitation in any activites – no symptoms of normal activites
Class II:    Mild limitation in some activities – comfortable at rest or mild exertion
Class III:    Marked limitation with activity – only comfortable at rest
Class IV:    Discomfort with activity and symptomatic at rest

According to American College of Cardiology/American Heart Assiciation – 4 stages of heart failure

Stage A:    High risk for heart failure in future – but no current structural change
Stage B:    Some structural change but no symptoms
Stage C:    Symptoms are present with an underlying structural change of heart – using medical treatment
Stage D:    Advance disease that requires hospital support, heart tranplant, or palliative care

Treatment

Stage A
•         Treat hypertension
•         Stop smoking
•         Stop Alcohol
•         Treat lipid disorders
•         ACE Inhibitors

Stage B
•         Inclusive of Stage A
•         ACE inhibitors
•         ARBs
•         Beta blockers
•         Implantable defibrillators

Stage C
•         Inclusive of Stage A and B
•         Diuretics
•         ACE inhibitors
•         Beta blockers
•         Aldosterone antagonist
•         ARBs
•         Digitalis
•         Hydralazine/nitrates
•         Biventricular pacing
•         Implantable defibrillators

Stage D
•         Inclusive of Stage A,B and C if appropriate
•         Hospice

*** – Hunt SA et al:ACC/AHA 2005 Guidelines

Diuretics

ACE Inhibitors

Angiotension II Receptor Blockers

Beta-Blockers

-   Initially were thought to be bad with patients with heart failure
-   Are now considered very beneficial
.           Carvedilol – a non selective Beta-1 and Beta-2
.           Bisoprolol
.           Metoprolol

Digitalis Glycosides
.           Digoxin

****Calcium Channel Blockers – should be avoided in almost all cases of CHF