Heart Failure

Heart Failure
• A clinical syndrome in which either structural or functional abnormalities
• The heart pumps insufficient oxygenated blood to meet the metabolic needs of the
tissues
• An elevated filling pressure.
? Left-sided (pulmonary edema)
? Right-sided ( hepatomegaly & systemic edema)
? both sides of the heart
? Exercise intolerance and fatigue are common
? A progressive disorder + M&M.
Stage Description Treatment
A No structural HD & no sym. but risk
factors: CAD, HTN, DM, cardio
toxins, familial cardiomyopathy
Lifestyle , exercise, smoking; hyperlipidemia &
ACEI for HTN
B Abnormal LV systolic F, MI, valvular
HD but no HF sym.
Lifestyle , ACEI, BB
C Structural HD & HF sym. Lifestyle, ACEI, BB, Diuretics, Digoxin
D Refractory HF sym. to maximal
medical management
Therapy listed under A, B, C & mechanical assist
device, heart transplant., continuous IV inotropic
infusion, hospice care in selected patients
I (mild) No sym. while performing ordinary physical activity (walking, climbing stairs, etc.)
II (mild) Mild sym.(mild shortness of breath, palpitations, fatigue, and/or angina) and slight limitation
during ordinary physical activity
III
(moderate)
Marked limitation in activity due to sym., even during less-than-ordinary activity (walking short
distances [20–100 m]). Comfortable only at res


Heart Failure
• A clinical syndrome in which either structural or functional abnormalities
• The heart pumps insufficient oxygenated blood to meet the metabolic needs of the
tissues
• An elevated filling pressure.
? Left-sided (pulmonary edema)
? Right-sided ( hepatomegaly & systemic edema)
? both sides of the heart
? Exercise intolerance and fatigue are common
? A progressive disorder + M&M.
Stage Description Treatment
A No structural HD & no sym. but risk
factors: CAD, HTN, DM, cardio
toxins, familial cardiomyopathy
Lifestyle , exercise, smoking; hyperlipidemia &
ACEI for HTN
B Abnormal LV systolic F, MI, valvular
HD but no HF sym.
Lifestyle , ACEI, BB
C Structural HD & HF sym. Lifestyle, ACEI, BB, Diuretics, Digoxin
D Refractory HF sym. to maximal
medical management
Therapy listed under A, B, C & mechanical assist
device, heart transplant., continuous IV inotropic
infusion, hospice care in selected patients
I (mild) No sym. while performing ordinary physical activity (walking, climbing stairs, etc.)
II (mild) Mild sym.(mild shortness of breath, palpitations, fatigue, and/or angina) and slight limitation
during ordinary physical activity
III
(moderate)
Marked limitation in activity due to sym., even during less-than-ordinary activity (walking short
distances [20–100 m]). Comfortable only at res


Heart Failure
• A clinical syndrome in which either structural or functional abnormalities
• The heart pumps insufficient oxygenated blood to meet the metabolic needs of the
tissues
• An elevated filling pressure.
? Left-sided (pulmonary edema)
? Right-sided ( hepatomegaly & systemic edema)
? both sides of the heart
? Exercise intolerance and fatigue are common
? A progressive disorder + M&M.
Stage Description Treatment
A No structural HD & no sym. but risk
factors: CAD, HTN, DM, cardio
toxins, familial cardiomyopathy
Lifestyle , exercise, smoking; hyperlipidemia &
ACEI for HTN
B Abnormal LV systolic F, MI, valvular
HD but no HF sym.
Lifestyle , ACEI, BB
C Structural HD & HF sym. Lifestyle, ACEI, BB, Diuretics, Digoxin
D Refractory HF sym. to maximal
medical management
Therapy listed under A, B, C & mechanical assist
device, heart transplant., continuous IV inotropic
infusion, hospice care in selected patients
I (mild) No sym. while performing ordinary physical activity (walking, climbing stairs, etc.)
II (mild) Mild sym.(mild shortness of breath, palpitations, fatigue, and/or angina) and slight limitation
during ordinary physical activity
III
(moderate)
Marked limitation in activity due to sym., even during less-than-ordinary activity (walking short
distances [20–100 m]). Comfortable only at res