l5

• Types of Heart Failure


  • May be Acute or Chronic
  • Left sided failure - Commonest due to hypertension
  • Right sided failure - Cor pulmonale due to chronic lung disease
  • Biventricular failure - Both chambers often affected
  • Left ventricular causes pulmonary congestion which can then lead to right sided failure
• Classification of Heart Failure


  • Class 1 - no symptoms during normal physical activity
  • Class 2 - comfortable at rest, normal physical activity triggers symptoms
  • Class 3 - comfortable at rest, minor physical activity triggers symptoms
  • Class 4 - unable to carry out any physical activity without discomfort, may have symptoms even when resting
• Types of Heart Failure


  • May be Acute or Chronic
  • Left sided failure - Commonest due to hypertension
  • Right sided failure - Cor pulmonale due to chronic lung disease
  • Biventricular failure - Both chambers often affected
  • Left ventricular causes pulmonary congestion which can then lead to right sided failure
• Classification of Heart Failure


  • Class 1 - no symptoms during normal physical activity
  • Class 2 - comfortable at rest, normal physical activity triggers symptoms
  • Class 3 - comfortable at rest, minor physical activity triggers symptoms
  • Class 4 - unable to carry out any physical activity without discomfort, may have symptoms even when resting
• Clinical Features of Heart Failure


  • Reduced ejection fraction <40% on echocardiogram - Stroke volume is reduced
  • Reduced exercise tolerance
  • Hypotension - tiredness and dizziness
  • Reduced urine flow
  • Cold peripheries
  • Breathlessness
  • Oedema
  • Atrial fibrillation - back pressure on atrium - dilatation - electrical disturbances
• Causes of Left-sided Heart Failure

  • Myocardial infarction
  • Over stretched heart
  • Leaky valves
  • Uncontrolled hypertension
• Clinical Features of Heart Failure

  • Reduced ejection fraction <40% on echocardiogram - Stroke volume is reduced
  • Reduced exercise tolerance
  • Hypotension - tiredness and dizziness
  • Reduced urine flow
  • Cold peripheries
  • Breathlessness
  • Oedema
  • Atrial fibrillation - back pressure on atrium - dilatation - electrical disturbances
• Causes of Left-sided Heart Failure

  • Myocardial infarction
  • Over stretched heart
  • Leaky valves
  • Uncontrolled hypertension
• Systolic Left-sided Heart Failure


  • Increase in volume of blood left in the left ventricle at the end of contraction
  • End Systolic Volume (ESV) increases
  • As more venous return refills the left ventricle during diastole the reduced systolic emptying leads to End Diastolic Volume (EDV) increasing
  • Stroke Volume (SV) reduces
• Systolic Left-sided Heart Failure

  • Increase in volume of blood left in the left ventricle at the end of contraction
  • End Systolic Volume (ESV) increases
  • As more venous return refills the left ventricle during diastole the reduced systolic emptying leads to End Diastolic Volume (EDV) increasing
  • Stroke Volume (SV) reduces
• Causes of Left-sided Heart Failure


  • Reduced compliance of ventricular wall
  • Left ventricular hypertrophy
  • Myocardial ischaemia - stiff ventricular wall, difficult to refill the ventricle
  • Cardiac tamponade (heart is physically compressed)
  • Narrowed mitral valve
• Diastolic Left-sided Heart Failure


  • Reduced ventricular compliance may lead to Diastolic Dysfunction resulting in Left Sided Heart Failure
  • Pressure in the ventricle during diastole is increased because of stiffness of the ventricular wall
  • End Diastolic Volume (EDV) reduces due to reduced filling of the ventricle
  • Stroke Volume (SV) reduces
• Causes of Left-sided Heart Failure


  • Reduced compliance of ventricular wall
  • Left ventricular hypertrophy
  • Myocardial ischaemia - stiff ventricular wall, difficult to refill the ventricle
  • Cardiac tamponade (heart is physically compressed)
  • Narrowed mitral valve
• Diastolic Left-sided Heart Failure


  • Reduced ventricular compliance may lead to Diastolic Dysfunction resulting in Left Sided Heart Failure
  • Pressure in the ventricle during diastole is increased because of stiffness of the ventricular wall
  • End Diastolic Volume (EDV) reduces due to reduced filling of the ventricle
  • Stroke Volume (SV) reduces
• Left ventricular performance curves (Frank-Starling curves)


  • (a) Cardiac performance increases as a function of pre-load (normal)
  • (b) With decreased ventricular contractility (heart failure) there is less ventricular emptying which increases end-diastolic volume (EDV) so the fall in stroke volume is less than it would otherwise have been
  • (c) Further increased left ventricular filling (EDV) leads to pulmonary congestion
• Left ventricular performance curves (Frank-Starling curves)

  • (a) Cardiac performance increases as a function of pre-load (normal)
  • (b) With decreased ventricular contractility (heart failure) there is less ventricular emptying which increases end-diastolic volume (EDV) so the fall in stroke volume is less than it would otherwise have been
  • (c) Further increased left ventricular filling (EDV) leads to pulmonary congestion
• We need to get back to 'a' - increase stroke volume/cardiac output


  How can excess fluid be quickly removed from the lungs? Diuretics
• We need to get back to 'a' - increase stroke volume/cardiac output


  How can excess fluid be quickly removed from the lungs? Diuretics