1. Heart Failure Khalid F AlHabib.MBBS.FRCPC Cardiology Consultant King Fahad Cardiac Centre King Saud University Wednesday, September 02, 2015Wednesday, September 02, 2015Wednesday, September 02, 2015Wednesday, September 02, 2015

2. Heart Failure: Outline  Definition  Causes  Epidemiology  Pathophysiology  Clinical Assessment  Management  Prognosis

3. 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.

4. CAUSES & FORMS

5. Systolic versus Diastolic HF

9. PREVALENCE & COST

10. 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. Heart Failure: a major public health problem

11. Prevalence of HF Increases with Age US, 1988–1994 AHA. Heart Disease and Stroke Statistics—2004 Update 0 2 4 6 8 10 20–2425–3435–4445–5455–6465–7475+ Age (yr) Population (%) Males Females

12. Estimated Direct and Indirect Costs of HF in US 8% 10% 7% 14% 53% Hospitalization $13.6 Lost Productivity/ Mortality* $2.1 Home Healthcare $2.1 Drugs/Other Medical Durables $2.7 Physicians/Other Professionals $1.8 Nursing Home $3.5 *Lost future earnings of persons who will die in 2004, discounted by 3% AHA. Heart Disease and Stroke Statistics—2004 Update Total Cost $25.8 billion

13. PATHOPHYSIOLOGY

20. CLINICAL EVALUATION

27. ACUTE VS. CHRONIC HEART FAILURE FEATUREACUTE HEART FAILURE DECOMPENSATED CHRONIC HEART FAILURE CHRONIC HEART FAILURE Symptom severityMarked Mild to moderate Pulmonary edemaFrequent Rare Peripheral edemaRareFrequent Weight gainNone to mildFrequent Whole-body fluid volume loadNo change or mild increaseModerate to marked increaseMild to marked increase CardiomegalyUncommonUsual*Common* Ventricular systolic functionReduced, normal, or hypercontractile Reduced* Wall stressElevatedMarkedly elevatedElevated Activation of sympathetic nervous systemMarked Mild to marked Activation of renin-angiotensin-aldosterone system Often increasedMarkedMild to marked Reparable, reversible causative lesion(s)CommonOccasional *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.

30. 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.

32. MANAGEMENT

36. PROGNOSIS

38. Causes of Hospital Readmission for Congestive Heart Failure 17% Other 19% Failure to Seek Care 16% Inappropriate Rx Rx Noncompliance 24% Diet Noncompliance 24% Annals of Internal Medicine 122:415-21, 1995 Over 2/3 of HF Hospitalizations Preventable

39. Prognosis with Heart Failure: More “Malignant” Than Cancer ! AHA, 1998 Heart and Statistical Update NCHS, National Center for Health Statistics Survival after the onset of congestive heart failure in Framingham Heart Study subjects Ho Circulation 1993;88:107-115 Years Overall 5-year mortality 50%

40. In Summary..