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

3. “ die hart is net ‘n pomp” 1968

7. 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)

8. 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

9. 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

10. 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……….

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

13. 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

14. chambers and valves
Ultrasound or sonar

16. 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

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

18. 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

19. 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).

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

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

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

23. Take your pills!

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

25. Postero-lateral

26. LVAD: artificial heart

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

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