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

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 - 2002)

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

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

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....

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

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

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

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.

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

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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

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

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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

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

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

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

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

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

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

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 15-30 min

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Measuring Jugular Venous Pressure

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