HEART FAILURE: a a pump in distress Dr Tom Mabin Vergelegen Mediclinic Somerset West Cardiac Support group September 2016

“ die hart is net ‘n pomp” 1968

Causes of heart failure Poorly controlled hypertension(high blood pressure) Myocardial infarctions(heart attacks) Uncontrolled Irregular heart rhythms(arrhythmias) Leaking heart valves Blocked heart valves Infections..viral toxins:/medications eg alcohol/chemotherapy Congenital Unknown(cardiomyopathy)

Heart failure:the size of the problem >10% of patients >70 years have HF Commonest cause of hospitalisation in >70 years Increasing frequency: ageing population; more survivors of myocardial infarction Most have high BP and /or heart attack history Diagnosis often missed: treatment delayed

Symptoms of heart failure Fatigue/tiredness/lack of energy Shortness of breath Inability to lie flat in bed at night(orthopnea) Swelling of legs/abdomen Blue extremities

Diagnosis of heart failure History History… CAUSES:- High blood pressure Heart attacks/angina Heart murmurs / valves Heart surgery Flu-like illnesses Toxins/chemotherapy CLINICAL EXAMINATION……….

Examination in heart failure Breathless Fast pulse BP fluid accumulation Neck veins elevated Ankle swelling (oedema) Lung congestion(crackles) Murmurs Abdominal swelling

Diagnosis of heart failure ECG Arrythmia Heart attacks Heart enlargement Echocardiogram Heart size Heart function..left ventricular performance (ejection fraction) Valve leaks and/or blockages Angiogram Coronary artery disease/ heart attckes

chambers and valves Ultrasound or sonar

Management of heart failure LIFESTYLE CHANGES: Restrict fluid intake: 1.5 Li/day: daily weighing Reduce salt intake Quit alcohol / cigarettes Reduce weight Regular moderate excercise

Management of heart failure Treat the cause: High BP Coronary disease: Stents/bypass Arrhythmia Attend to the valve lesion if appropriate eg surgery

Management of heart failure Treat the symptoms Diuretics: remove the water Ace inhibitors: assist the heart Beta-blockers: assist the heart; slow the pulse Specialised medications

The Donkey Analogy Heart failure limits a patient's ability to perform the routine activities of daily living… Let’s compare our heart to this donkey, and our body to the wagon that this donkey has to pull every day. A healthy heart is like an energetic donkey, which without fatigue, pulls the wagon full of weights. Conversely, a diseased heart will have difficulty meeting metabolic demands (or pulling the wagon).

Diuretics Reduce the number of sacks on the wagon eg: lasix: puresis: spiractin

ACE inhibitors Reduce the number of sacks on the wagon eg:prexum; pearinda;zartan;

ß-Blockers Limit the donkey’s speed, thus saving energy Dilatrend; Carloc; Bilocor

Take your pills!

Management of heart failure Specialised devices Pacemakers Artificial mechanical hearts Heart transplant

Postero-lateral

LVAD: artificial heart

Pacemakers(CRT) and mechanical heart(LVAD) Increase the donkey’s (heart) efficiency

“ die hart is net ‘n pomp” 1968……..2016