1. Systolic Versus Diastolic Failure

2. Forms of Heart Failure Sytolic Failure Inability of the ventricle to contract normally and expel sufficient blood Inadequate cardiac output with weakness, fatigue, reduced exercise tolerance (hypoperfusion) Diastolic Failure Inability to relax or fill normally (elevation of filling pressures) Due to increased resistance to ventricular diastolic capacity, impaired ventricular relaxation, and myocardial fibrosis and infiltration

3. Management

6. Congestive Heart Failure Patients With Reduced Left Ventricular Ejection Fraction – If with fluid retention: Use diuretics (thiazides) – Medications that should be AVOIDED: Anti-arrhythmics Calcium channel blockers NSAIDs Circulation; Journal of the AHA http://circ.ahajournals.org/cgi/content/full/119/14/1977

7. Congestive Heart Failure Patients With Reduced Left Ventricular Ejection Fraction – Recommendations concerning aldosterone antagonists: carefully selected patients with moderately severe or severe HF symptoms and recent decompensation or with LV dysfunction early after MI Circulation; Journal of the AHA http://circ.ahajournals.org/cgi/content/full/119/14/1977

8. Congestive Heart Failure Patients With Refractory End-Stage Heart Failure (Stage D) – Intravenous Peripheral Vasodilators and Positive Inotropic Agents: hospitalized frequently for clinical deterioration, and during such admissions, they commonly receive infusions of both positive inotropic agents (dobutamine, dopamine, or milrinone) and vasodilator drugs (nitroglycerin, nitroprusside, or nesiritide) Circulation; Journal of the AHA http://circ.ahajournals.org/cgi/content/full/119/14/1977

9. Congestive Heart Failure The Hospitalized Patient Common Factors That Precipitate Hospitalization for Heart Failure Noncompliance with medical regimen, sodium and/or fluid restriction Acute myocardial ischemia Uncorrected high blood pressure Atrial fibrillation and other arrhythmias Circulation; Journal of the AHA http://circ.ahajournals.org/cgi/content/full/119/14/1977

10. Congestive Heart Failure The Hospitalized Patient Common Factors That Precipitate Hospitalization for Heart Failure Recent addition of negative inotropic drugs (e.g., verapamil, nifedipine, diltiazem, beta blockers) Pulmonary embolus Nonsteroidal anti-inflammatory drugs Circulation; Journal of the AHA http://circ.ahajournals.org/cgi/content/full/119/14/1977

11. Congestive Heart Failure The Hospitalized Patient Common Factors That Precipitate Hospitalization for Heart Failure Excessive alcohol or illicit drug use Endocrine abnormalities (e.g., diabetes mellitus, hyperthyroidism, hypothyroidism) Concurrent infections (e.g., pneumonia, viral illnesses) Circulation; Journal of the AHA http://circ.ahajournals.org/cgi/content/full/119/14/1977