Understanding Heart Failure: Symptoms and Treatments

Oct 24, 2024

Lecture Notes on Heart Failure

Overview

  • Heart Failure: Leading health issue in the U.S.
    • Over 5 million diagnosed.
    • High mortality: Half die within 5 years.
    • Economic impact: High costs, decreased productivity and quality of life.

Pathophysiology

  • Mean Arterial Pressure (MAP): Cardiac output x systemic vascular resistance.
  • Cardiac Output: Heart rate x stroke volume.
    • Stroke volume: Contractility x preload (fluid volume).
  • Systemic Vascular Resistance: Blood pressure, impacts heart workload.

Compensatory Mechanisms

  • Beta-1 receptors increase heart rate and contractility.
  • In heart failure, these can lead to ventricular remodeling, a negative outcome.

Neural and Hormonal Effects

  • Neural: Beta-1 receptors' impact.
  • Hormonal: Renin-angiotensin-aldosterone system.
    • Poor renal perfusion leads to renin release.
    • Angiotensin II causes vasoconstriction, increasing resistance.
    • Aldosterone increases sodium reabsorption, worsening fluid retention.

Types of Heart Failure

  • Left-sided Heart Failure: Fluid backs up into the lungs.
    • Symptoms: Dyspnea, orthopnea, tachycardia, crackles.
  • Right-sided Heart Failure: Fluid backs up into the body.
    • Symptoms: Peripheral edema, weight gain, JVD, liver issues.

Diagnostic Approach

  • History & Physical Exam: Identify underlying causes.
    • Family history, past illnesses, medication review.
  • Tests:
    • Chest X-ray: Pulmonary edema, cardiomegaly.
    • BNP levels: Indicator, but can be misleading in obesity or renal failure.
    • ECG: Check for arrhythmias, hypertrophy, previous MI.
    • Echocardiogram: Ejection fraction, ventricle size.
    • Check for anemia, infection, electrolyte imbalance.

Treatment

  • Goals: Reduce cardiac workload, optimize ventricular function, manage comorbidities.
  • Medication Management:
    • Beta Blockers & ARB/Neprolysin Inhibitors: Standard for all patients.
    • SGLT2 Inhibitors and Spironolactone: For symptomatic patients before diuretics.
    • Loop Diuretics: As symptoms worsen.
    • Lifestyle Changes: Daily weights, sodium/fluid management, smoking and alcohol restrictions.

Advanced Interventions

  • Devices: Automated defibrillators, pacemakers for severe cases.
  • Transplant Candidates: Continuous inotropes or left ventricular assist devices as bridges.

Acute Heart Failure Management

  • Acute Setting: Diuresis, oxygen, CPAP.
  • Post-Acute: Optimize therapy with additional medications.

Heart Failure with Preserved Ejection Fraction

  • Causes: Hypertension, aging, ischemic heart disease.
  • Similar treatment, with extra hypertension control focus.

Comorbidities

  • Iron Deficiency: IV iron recommended for functional improvement.
  • Hypertension Control: Target less than 130, possibly 120.
  • Sleep Apnea: Assess as it can contribute to heart failure.

Important Points

  • Heart failure treatment focuses on reducing remodeling, improving quality of life, and decreasing hospitalizations.
  • Monitor symptoms and adjust treatment to prevent progression.

Note: The above notes are a summary of a lecture on heart failure, covering its pathophysiology, diagnosis, and treatment strategies.

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