Intro Chronic Heart Failure

• Heart Failure Definition:

  • An inability of the heart to pump sufficient amounts of blood to meet the metabolic demands of the tissue
• Chronic Heart Failure:

  • chronic heart failure is the final common pathway of nearly every form of cardiac disease including; coronary artery disease, valve disease, hypertension, congenital heart disease and cardiomyopathies
  • That is to say that if these primary diseases don’t induce mortality, they will over time devolve into chronic heart disease
  • Once diagnosed with chronic heart failure an individual’s prognosis is on a sliding scale of poor to very poor
  • Ultimately it is a life limiting and life shortening condition
• In thinking about an individual with CHF it’s necessary to establish the following:

  • What structure is specifically failing i.e. the left or right or both ventricles?
  • How is it failing, i.e. is a ventricle(s) failing to fill or to empty or in other words are we looking at a systolic or diastolic failure?
  • What is happening to the patient’s ejection fraction – i.e. is it normal (because filling is low) or low (because emptying is low) – remember it’s a fraction you need to consider
  • What is causing the failure?
  • How severe is the failure?
  • How does the subject present?
  • What can be done to reduce the individual’s mortality risk and improve their quality of life?
• Incidence of CHF:

  • ~ 900000 in UK
  • > 10% population over 70 years
  • causes or complicates:
  • ~ 5% NHS emergency admissions
  • ~ 2% NHS bed days
• What is causing heart failure:

  • heart failure relates to failure of the ventricles
  • left or right sided failure?
  • failing to fill? (diastolic failure)
  • failing to empty? (systolic failure)
  • both failure reduce cardiac output