1. Congestive Heart Failure Symptoms & signs
BY : DR.F.Sahebjamee
Cardiologist
Congestive Heart Failure (CHF)
Kathy Green, MS, RN
Patient Health Education

2. Heart Failure Incidence and Prevalence
Worldwide – 22 million
United States – 5 million
♥ Incidence
Worldwide – 2 million new cases year
United States – 500,000 new cases year
Heart Failure Incidence and Prevalence
♥ Prevalence
Worldwide – 22 million
United States – 5 million
♥ Incidence
Worldwide – 2 million new cases year
United States – 500,000 new cases year
♥ Afflicts 10 out of every 1,000 people over age 65 in the United States
(Stats from American Heart association )

3. 2 Types of Heart Failure Systolic Dysfunction
(Contraction) 2/3 of Patients
♥ The heart becomes weak and enlarged
♥ The weakened heart muscle can’t contract
♥ Not enough blood is pumped from the chambers
Diastolic Dysfunction
(Relaxation)
♥ Chambers don’t fill up so less blood goes to the lungs and body
♥ Stiff heart muscle can’t relax
♥ Not enough blood fills the chambers
2 Types of Heart Failure
Systolic Dysfunction
(Contraction) 2/3 of Patients
♥ The heart becomes weak and enlarged
♥ The weakened heart muscle can’t contract
♥ Not enough blood is pumped from the chambers
Diastolic Dysfunction
(Relaxation)
♥ Chambers don’t fill up so less blood goes to the lungs and body
♥ Stiff heart muscle can’t relax
♥ Not enough blood fills the chambers

4. forward failure: decreased blood supply
Symptoms and signs of heart failure
forward failure:
symptoms result from inability of the heart to pump enough
blood to the periphery (from left heart), or to the lungs (from
the right heart)
a) forward failure of left heart:- muscle weakness, fatigue,
dyspepsia, oliguria....
 general mechanism: tissue hypoperfusion
b) forward failure of right heart: - hypoperfusion of the
lungs  disorders of gas
exchange
decreased blood supply
to the left heart

5. 2. backward failure:
– symptoms result from inability of the heart to accept
the blood comming from periphery and from lungs
backward failure of left heart:
– increased pulmonary capillary pressure  dyspnea
and tachypnoea, pulmonary edema (cardiac asthma) 
 arterial hypoxemia and hypercapnia....
b. backward failure of right heart:
– increased pressure in systemic venous system 
 peripheral edemas, hepatomegaly, ascites nocturnal diuresis....

6. New York Heart Association Functional Classification
No symptoms with ordinary activity
Class II
Slight limitation of physical activity results in fatigue, shortness of breath, chest pain or irregular heart beat
New York Heart Association Functional Classification
Class I
No symptoms with ordinary activity
Class II
Slight limitation of physical activity results in fatigue, shortness of breath, chest pain or irregular heart beat

7. New York Heart Association Functional Classification
Class III
Marked limitation of physical activity.
Comfortable at rest, but less than ordinary physical activity results in fatigue, irregular heart beat, pain or shortness of breath
Class IV
Unable to carry out any physical activity without discomfort
All symptoms in class III even at rest
New York Heart Association Functional Classification
Class III
Marked limitation of physical activity.
Comfortable at rest, but less than ordinary physical activity results in fatigue, irregular heart beat, pain or shortness of breath
Class IV
Unable to carry out any physical activity without discomfort
All symptoms in class III even at rest

8. Systolic Heart Failure by NYHA Class
Class IV
240 K
(5%)
Class I
1.68 M
(35%)
Class III
1.20 M
(25%)
Class II
1.68 M
(35%)
AHA Heart and Stroke Statistical Update 2009

9. unNatural History of Heart Failure
100 75 50 25 I II
III IV 1 10
NYHA CLASS
Annual Survival Rate
Hospitalizations / year .1
Deceased
Advanced Heart Failure
N=200,000
age 65 (50%)
# of meds (9)
# hosp (5)
$$$ (12 billion)
Mortality (50%/yr)
Rx???
Survival Rate
Hospitalizations
This slide demonstrates the importance of treating heart failure in Stage III, since waiting until Stage IV leaves very few options for treatment.
Admission of a heart failure patient to hospital is a warning sign that this patient requires intervention.
Adapted from Bristow, MR Management of Heart Failure, Heart Disease: A Textbook of Cardiovascular Medicine, 6th edition, ed. Braunwald et al.

10. Symptoms and Mortality
Class IV
Class II-III
Class III-IV
Class I

11. The End

12. Early Symptoms of Heart Failure
♥ A weight gain or loss of 2 or more pounds in 1 day, or 4 pounds in 1 week
♥ Confusion, restlessness or lightheaded
♥ A feeling of fullness or bloating in your stomach
♥ Cough, shortness of breath, swelling
♥ Fatigue, lose of appetite, or nausea
Early Symptoms of Heart Failure
♥ A weight gain or loss of 2 or more pounds in 1 day, or 4 pounds in 1 week
♥ Confusion, restlessness or lightheaded
♥ A feeling of fullness or bloating in your stomach
♥ Cough, shortness of breath, swelling
♥ Fatigue, lose of appetite, or nausea

13. Urgent Symptoms of Heart Failure
♥ Increased shortness of breath while resting or trouble sleeping
♥ Waking up suddenly at night due to difficulty breathing
♥ A need to sleep sitting up or a need for more pillows than usual
♥ A fast irregular heart beat, a racing heart that makes you feel dizzy, or like you are going to pass out
♥ Coughing up pink frothy mucus
Urgent Symptoms of Heart Failure
♥ Increased shortness of breath while resting or trouble sleeping
♥ Waking up suddenly at night due to difficulty breathing
♥ A need to sleep sitting up or a need for more pillows than usual
♥ A fast irregular heart beat, a racing heart that makes you feel dizzy, or like you are going to pass out
♥ Coughing up pink frothy mucus

14. The End

15. DYSPNEA Abnormally uncomfortable awareness of breathing
Dyspnea after strenous activity- NORMAL INDIVIDUAL
Dyspnea after moderate activity – DECONDITIONED INDIVIDUAL
Dyspnea becomes abnormal only if it occurs at rest or at a level of activity not expected to cause dyspnea

16. DIFFERENTIAL DIAGNOSIS OF DYSPNEA
PULMONARY
- Reactive airways disease
- COPD
- pulmoary edema
- pulmonary hypertension
- infection
- pulmonary embolism
- pleural diseases
- interstitial lung disease

17. DIFFERENTIAL DIAGNOSIS OF DYSPNEA
CARDIAC
-ischemic heart dsease
- right sided heart failure
- arrhythmias
- dilated cardiomyopathy
- hypertrophic cardiomyopathy
- valve stenosis and regurgitation

18. ACUTE DYSPNEA Sudden development of dyspnea - pulmonary embolism
- pneumonia
- airway obstruction
- Spontaneous pnumothorax
- Pulmonary Edema

19. CHRONIC DYSPNEA Symptom progress slowly or gradual - HEART FAILURE
- COPD(chronic obstructive pulmonary disease)

20. DYSPNEA INSPIRATORY DYSPNEA- obstruction in upper airway
EXPIRATORY DYSPNEA- obstruction of lower respiratory tract
EXCERTIONAL DYSPNEA- left ventricular failure or COPD
FUNCTIONAL DYSPNEA- dyspnea at rest and not during activity

21. ORTHOPNEA Inability to breath comfortably when lying
Severe pulmonary venous congestion is the cause of orthopnea
Usually seen in advance heart failure were resting pulmonary venous pressure is elevated

22. PAROXYSMAL NOCTURNAL DYSPNEA
Interstitial or intera alveolar pulmonary edema
Secondary to ventricular failure
Symptom starts 2-4 hours after sleeping, patient arise from sleep feeling short of breath
Symptom ameliorated by sitting on the side of bed and take about min

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26. Measuring Jugular Venous Pressure

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