Cardiac Failure

CARDIAC FAILURE
 Heart failure or cardiac failure is a syndrome of ventricular dysfunction.

 Left ventricular (LV) failure – causes shortness of breath and fatigue
 Right ventricular (RV) failure – causes peripheral and abdominal fluid accumulation
 The ventricles can be involved together or separately.
PATHOPHYSIOLOGY OF CARDIAC FAILURE

In cardiac failure, the heart may not provide tissues with adequate blood for metabolic needs,
and cardiac-related elevation of pulmonary or systemic venous pressures may result in organ
congestion. This condition can result from abnormalities of systolic or diastolic function or,
commonly, both.
1. Left Ventricular Failure

 In heart failure that involves left ventricular dysfunction, CO decreases and pulmonary
venous pressure increases. When pulmonary capillary pressure exceeds the oncotic
pressure of plasma proteins (about 24 mm Hg), fluid extravasates from the capillaries
into the interstitial space and alveoli, reducing pulmonary compliance and increasing
the work of breathing.
2. Right Ventricular Failure

 In heart failure that involves right ventricular dysfunction, systemic venous pressure
increases, causing fluid extravasation and consequent edema, primarily in dependent
tissues (feet and ankles of ambulatory patients) and abdominal viscera. The liver is
most severely affected, but the stomach and intestine also become congested; fluid
accumulation in the peritoneal cavity (ascites) can occur.
Frank-Starling principle
 Normally (top curve), as preload increases, cardiac performance also increases. However, at a
certain point, performance plateaus, then declines. In heart failure (HF) due to systolic
dysfunction (bottom curve), the overall curve shifts downward, reflecting reduced cardiac
performance at a given preload, and as preload increases, cardiac performance increases
less. With treatment (middle curve), performance is improved, although not normalized.
Video: Overview of Heart Failure
https://www.youtube.com/watch?v=ypYI_lmLD7g
DIAGNOSIS OF HEART FAILURE

 Clinical evaluation
- Clinical findings (eg, exertional dyspnea or fatigue, orthopnea, edema, tachycardia,
pulmonary crackles, S3, jugular venous distention) suggest heart failure but are usually
not apparent early.
 Chest x-ray
- Chest x-ray findings suggesting heart failure include an enlarged cardiac silhouette,
pleural effusion, fluid in the major fissure, and horizontal lines in the periphery of lower
posterior lung fields (Kerley B lines)
Sample Chest X-Ray of a Patient with Bilateral Pleural Effusions
 Echocardiography
- It can help evaluate chamber dimensions, valve function, LVEF, wall motion
abnormalities, LV hypertrophy, diastolic function, pulmonary artery pressure, LV and RV
filling pressures, RV function, and pericardial effusion.
 Radionuclide Imaging
- To help assess systolic and diastolic function, previous MI (myocardial infarction), and
inducible ischemia or myocardial hibernation. It is used most commonly to assess the
presence and/or severity of ischemic heart disease and can also be used to quantify left
ventricular ejection fraction.
 Cardiac MRI
- It provides accurate images of cardiac structures and is becoming more widely available.
Cardiac MRI using late gadolinium enhancement imaging (LGE, also called fibrosis or
scar imaging) is useful to evaluate the cause of myocardial disease and to detect focal
and diffuse myocardial fibrosis
 BNP or N-terminal-pro-BNP (NT-pro-BNP) levels
- Serum BNP levels are often high in heart failure; this finding may help when clinical
findings are unclear or other diagnoses (eg, COPD) need to be excluded. It may be
particularly useful for patients with a history of both pulmonary and cardiac disorders. NT-
pro-BNP, an inactive moiety created when pro-BNP is cleaved, can be used similarly to
BNP
 ECG
- ECG findings are not diagnostic, but an abnormal ECG, especially showing previous
myocardial infarction, left ventricular hypertrophy, left bundle branch block, or
tachyarrhythmia (eg, rapid atrial fibrillation), increases suspicion for HF and may help
identify the cause.
 Thoracic ultrasonography
- A noninvasive method of detecting pulmonary congestion in patients with heart failure.
Sonographic "comet tail artifact" on thoracic ultrasonography corresponds to the x-ray
finding of Kerley B lines.
Comet Tail Artifact
 Coronary angiography or CT coronary angiography

- It is indicated when coronary artery disease is suspected or the etiology of HF is
uncertain.
Diagnosis of heart failure of acute onset (McDonagh, T.A., Metra, M., Adamo, M., et al, 2021)
Treatment of Cardiac Failure
 Diet and lifestyle changes
 Treatment of cause
 Drug therapy
 Drug treatment of heart failure involves symptom relief with
 Diuretics
 Nitrates
 Digoxin
 Drug treatment for long-term management and improved survival with
 ACE inhibitors
 Beta-blockers
 Aldosterone antagonists
 ARBs
 ARNIs
 SGLT2
 Sinus node inhibitors
 Device therapy (eg, implantable cardioverter-defibrillator, cardiac resynchronization therapy,
mechanical circulatory support)
 Cardiac transplantation
 Multidisciplinary care
The primary goal is to diagnose and to correct or treat the disorder that led to heart
failure.
Short-term goals include relieving symptoms and improving hemodynamics;
avoiding hypokalemia, renal dysfunction, and symptomatic hypotension; and correcting
neurohumoral activation.
Long-term goals include correcting hypertension, preventing myocardial infarction and
progression of atherosclerosis, improving cardiac function, reducing hospitalizations, and
improving survival and quality of life.
Management
 Dietary sodium restriction
 Monitoring daily morning weight
 Intensive case management (monitoring drug adherence and frequency of unscheduled visits
to the physician)
 Regular light activity (e.g., walking)
REFERENCES:
1. Fine, N. (2022). Heart Failure. Retrieved, February 13, 2023, from
https://www.msdmanuals.com/professional/cardiovascular-disorders/heart-failure/heart-
failure-hf
2. McDonagh TA, Metra M, Adamo M, et al: 2021 ESC Guidelines for the diagnosis and
treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis
and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)
with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart
J 42(36):3599-3726, 2021. doi: 10.1093/eurheartj/ehab368
3. Heidenreich PA, Bozkurt B, Aguilar D, et al: 2022 AHA/ACC/HFSA Guideline for the
Management of Heart Failure: A report of the American College of Cardiology/American
Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 145:e876–
e894, 2022, doi: 10.1161/CIR.0000000000001062
4. Packer M, Anker SD, Butler J, et al: Cardiovascular and renal outcomes with empagliflozin in
heart failure. N Engl J Med 383(15):1413-1424, 2020. doi: 10.1056/NEJMoa2022190. Epub
2020 Aug 28. PMID: 32865377.
5. Anker SD, Butler J, Filippatos G, et al: Empagliflozin in heart failure with a preserved ejection
fraction. N Engl J Med 385(16):1451-1461, 2021. doi: 10.1056/NEJMoa2107038. Epub 2021
Aug 27. PMID: 34449189.
6. Shah SJ, Kitzman D, Borlaug B, et al: Phenotype-specific treatment of heart failure with
preserved ejection fraction: A multiorgan roadmap. Circulation 134(1):73–90, 2016. doi:
10.1161/CIRCULATIONAHA.116.021884
7. Kober L, Thune JJ, Nielsen JC, et al: Defibrillator implantation in patients with nonischemic
systolic heart failure. N Engl J Med 375(13):1221–2130, 2016. doi: 10.1056/NEJMoa1608029
8. Stone GW, Lindenfield J, Abraham WT, et al: Transcatheter mitral-valve repair in patients
with heart failure. N Engl J Med 379(24):2307–2318, 2018. doi: 10.1056/NEJMoa1806640

Cardiac Failure

Uploaded by

Copyright:

Available Formats

Cardiac Failure

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Cardiac Failure

Uploaded by

Copyright:

Available Formats

CARDIAC FAILURE

 Heart failure or cardiac failure is a syndrome of ventricular dysfunction.

PATHOPHYSIOLOGY OF CARDIAC FAILURE

1. Left Ventricular Failure

2. Right Ventricular Failure

DIAGNOSIS OF HEART FAILURE

Sample Chest X-Ray of a Patient with Bilateral Pleural Effusions

Comet Tail Artifact

 Coronary angiography or CT coronary angiography

You might also like