Heart Failure

Hear Failure is the Inability of the heart to pump blood at a rate that the body requires to meet its demands

It is a very common condition with 1 in 100 people in the community suffering from it and 1 :1000 people will develop it every year.

Symptoms

Chest Pain

Shortness of Breath

Decrease in exercise tolerance

Ankle swelling

Leg swelling

Abdominal Swelling

Inability to lie flat during sleep

Waking up at night gasping for breath

Dizziness

The video below shows the transition from normal heart to heart failure

 

IS HEART FAILURE DASNGEROUS
strong>Heart failure needs treatment. With the advent of new drugs, more and more people are living longer and healthier.

The Figure below shows the number of people surviving after a diagnosis of heart failure. After 1 year year, 1 in 4 are dead.

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RISK OF SUDDEN DEATH WITH HEART FAILURE
People with heart failure can die of heart failure, due to abnormal rhythm (sudden death) or due to unrelated conditions.

The figure below shows the percentage of people who die according to symptoms.

 

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NYHA refers to the symptom state of a patient. It is an easy way to describe a patient state.

 

NYHA Class Symptoms
I Cardiac disease, but no symptoms and no limitation in ordinary physical activity, e.g. no shortness of breath when walking, climbing stairs etc.
II Mild symptoms (mild shortness of breath and/or angina) and slight limitation during ordinary activity.
III Marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g. walking short distances (20–100 m).
Comfortable only at rest.
IV Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients.

The pointers to dangerous/life threatening heart rythms include

  1. NYHA ( Functional Status)
  2. Ejection Fraction
  3. QRS duration ( How good are the conducting system of the heart

REDUCING THE RISK OF SUDDEN DEATH IN HEART FAILURE


A Defibrillator can help in some patients.

These are high powered devices, similar to a pacemaker that is implanted under the skin.

Patients with heart failure need to be considered for an AICD

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IMPROVING SYMPTOMS AND REDUCING MORTALITY IN HEART FAILURE
strong>First we have to make sure that reversible causes are assessed ad dealt with eg surgery for narrowing of the arteries or heart valves.

Medications have improved the survival dramatically over the past 2 decades.

The figure below shows the survival with the various combination of drugs

ACE- I/ARB: Angiotensin Convertin Enzyme Inhibitors ( e.g Ramipril, Enalapril etc)

ARB: Angiotensin II receptor antagonists ( eg: Candersatan)

MRA: Meneralocorticoid Receptor Antagonist ( e.g Spironolactone, Eplerenone)

CRT: Cardiac Resynchronisation Therapy

ICD:Implantable Cardioverter-Defibrillator

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