1. Heart Failure Daniel E. van Buren, M.D. New England Heart Institute
Androcsoggin Valley Hosptital

3. How Many People Have Heart Failure?
Heart failure is very common
It is the number one reason why people are admitted into hospitals in the U.S.
Heart failure effects nearly 5 million Americans
An estimated 400,000 to 700,000 new cases are diagnosed each year

4. Heart Failure
What is Heart Failure?

5. Heart Failure Does NOT mean…
Your heart has stopped working
Your heart is about to stop working
You have had a heart attack

6. Heart Failure What is Heart Failure?
The heart is not pumping as well as it should
Usually, the heart has been weakened by an underlying condition
Blocked arteries
Heart attack
High blood pressure
Diabetes
Infections
Heart valve abnormalities

7. Heart Failure What is Heart Failure?
Heart failure can involve the left or right side of the heart or both
Usually the left side is affected first
Heart failure occurs when either side of the heart cannot keep up with the flow of blood

8. Heart Failure What is Left Heart Failure?
Involves the left ventricle (lower chamber) of the heart
Systolic failure
The heart looses it’s ability to contract or pump blood into the circulation
Diastolic failure
The heart looses it’s ability to relax because it becomes stiff
Heart cannot fill properly between each beat and less blood in means less blood out.

10. Heart Failure What is Left Heart Failure?
In both types, blood may “back up” in the lungs causing fluid to leak into the lungs (pulmonary edema)
Fluid may also build up in tissues throughout the body (edema)

11. Heart Failure What is Right Heart Failure?
Usually occurs as a result of left heart failure
The right ventricle pumps blood to the lungs for oxygen
Occasionally isolated right heart failure can occur due to lung disease or blood clots to the lung (pulmonary embolism)

13. Heart Failure How fast does heart failure develop?
Usually a chronic disease
The heart tries to compensate for the loss in pumping function by:
Developing more muscle mass
Enlarging
Pumping faster

14. Heart Failure What Causes Heart Failure?
Health conditions that either damage the heart or make it work too hard
Coronary artery disease
Heart attack
High blood pressure
Abnormal heart valves
Heart muscle diseases (cardiomyopathy)
Heart inflammation (myocarditis)

15. Heart Failure What Causes Heart Failure? Congenital heart defects
Severe lung disease
Diabetes
Severe anemia
Overactive thyroid gland (hyperthyroidism)
Abnormal heart rhythms

16. Heart Failure What Causes Heart Failure? Coronary artery disease
                           
What Causes Heart Failure?
Coronary artery disease
Cholesterol and fatty deposits build up in the heart’s arteries
Less blood and oxygen reach the heart muscle
This causes the heart to work harder and occasionally damages the heart muscle

17. Heart Failure What Causes Heart Failure? Heart attack
                           
What Causes Heart Failure?
Heart attack
An artery supplying blood to the heart becomes blocked
Loss of oxygen and nutrients damages heart muscle tissue causing it to die
Remaining healthy heart muscle must pump harder to keep up

18. Heart Failure What Causes Heart Failure? High blood pressure
Uncontrolled high blood pressure doubles a persons risk of developing heart failure
Heart must pump harder to keep blood circulating
Over time, chamber first thickens, then gets larger and weaker
                           

19. Heart Failure What Causes Heart Failure? Abnormal heart valves
Heart muscle disease
Damage to heart muscle due to drugs, alcohol or infections
Congenital heart disease
Severe lung disease
                           

20. Heart Failure What Causes Heart Failure? Diabetes
Tend to have other conditions that make the heart work harder
Obesity
Hypertension
High cholesterol
                           

21. Heart Failure What Causes Heart Failure? Severe anemia Hyperthyroidism
Not enough red blood cells to carry oxygen
Heart beats faster and can become overtaxed with the effort
Hyperthyroidism
Body metabolism is increased and overworks the heart
Abnormal Heart Rhythm
If the heart beats too fast, too slow or irregular it may not be able to pump enough blood to the body
                                 
                            

22. What Are The Symptoms of Heart Failure?
Think FACES…
Fatigue
Activities limited
Chest congestion
Edema
Shortness of breath

23. Heart Failure Signs and Symptoms of Heart Failure
Shortness of Breath (dyspnea)
WHY?
Blood “backs up” in the pulmonary veins because the heart can’t keep up with the supply an fluid leaks into the lungs
SYMPTOMS
Dyspnea on exertion or at rest
Difficulty breathing when lying flat
Waking up short of breath
                           

24. Heart Failure Signs and Symptoms of Heart Failure
Persistent Cough or Wheezing
WHY?
Fluid “backs up” in the lungs
SYMPTOMS
Coughing that produces white or pink blood-tinged sputum
                           

26. Heart Failure Signs and Symptoms of Heart Failure Edema WHY? SYMPTOMS
Decreased blood flow out of the weak heart
Blood returning to the heart from the veins “backs up” causing fluid to build up in tissues
SYMPTOMS
Swelling in feet, ankles, legs or abdomen
Weight gain
                           

27. Heart Failure Signs and Symptoms of Heart Failure Tiredness, fatigue
WHY?
Heart can’t pump enough blood to meet needs of bodies tissues
Body diverts blood away from less vital organs (muscles in limbs) and sends it to the heart and brain
SYMPTOMS
Constant tired feeling
Difficulty with everyday activities
                           

28. Heart Failure Signs and Symptoms of Heart Failure
Lack of appetite/ Nausea
WHY?
Blood backs up causing swelling of the digestive tract
The digestive system receives less blood causing problems with digestion
SYMPTOMS
Feeling of being full or sick to your stomach
                           

29. Heart Failure Signs and Symptoms of Heart Failure
Confusion/ Impaired thinking
WHY?
Changing levels of substances in the blood ( sodium) can cause confusion
SYMPTOMS
Cognitive slowing
Memory loss or feeling of disorientation
Relative or caregiver may notice this first
                           

30. Heart Failure Signs and Symptoms of Heart Failure Increased heart rate
WHY?
The heart beats faster to “make up for” the loss in pumping function
SYMPTOMS
Heart palpitations
May feel like the heart is racing or throbbing
                           

31. Your Doctor May Run These Tests…
Electrocardiogram (“EKG” or “ECG”)
Echocardiogram (“Echo”)
Chest x-ray
Cardiac Catheterization (“Cath”)

32. What is Ejection Fraction (“EF”)?

33. Heart Failure Treatment Options
The more common forms of heart failure cannot be cured, but can be treated
Lifestyle changes
Medications
Surgery and device implantations
                           

34. Heart Failure
New York Heart Association (NYHA) Functional Classification
                           
Class
% of patients
Symptoms I
35%
No symptoms or limitations in ordinary physical activity II
Mild symptoms and slight limitation during ordinary activity
III
25%
Marked limitation in activity even during minimal activity. Comfortable only at rest IV 5%
Severe limitation. Experiences symptoms even at rest

35. Heart Failure Lifestyle changes Stop smoking Loose weight
Avoid alcohol
Avoid or limit caffeine
Eat a low-fat, low-sodium diet
Exercise
                           

36. Heart Failure Lifestyle changes Reduce stress
Keep track of symptoms and weight and report any changes or concern to the doctor
Limit fluid intake
See the doctor more frequently
                           

37. Heart Failure Medications used to treat Heart Failure ACE Inhibitors
Cornerstone of heart failure therapy
Proven to slow the progression of heart failure
Vasodilator – cause blood vessels to expand lowering blood pressure and the hearts work load
Directly inhibit “remodeling”
Improves symptoms, reduces hospitalizations, slows progression of disease and reduces mortality
                           

38. Heart Failure Medications used to treat Heart Failure Beta-blockers
Lower the heart rate and blood pressure
Decrease the workload of the heart
Inhibit “remodeling”
Improves symptoms, reduces hospitalizations, slows progression of disease and reduces mortality
                           

39. Heart Failure Medications used to treat Heart Failure
Aldosterone antagonists
Alters hormones that are damaging to the heart
Given for advanced heart failure
Inhibit “remodeling”
Improves symptoms, reduces hospitalizations, slows progression of disease and reduces mortality
                           

40. Heart Failure Medications used to treat Heart Failure Vasodilators
Cause blood vessel walls to relax
Occasionally used if patient cannot tolerate ACE inhibitors
Decrease workload of the heart
                           

41. Heart Failure Medications used to treat Heart Failure
Diuretics (water pills)
Prescribed for fluid build up, swelling or edema
Cause kidneys to remove more sodium and water from the bloodstream
Decreases workload of the heart and edema
Fine balance – removing too much fluid can strain kidneys or cause low blood pressure
Improves symptoms and reduces hospitalizations
                           

42. Heart Failure Medications used to treat Heart Failure
Digitalis preparations
Increases the force of the hearts contractions
Relieves symptoms
Slows heart rate and certain irregular heart beats
Improves symptoms and reduces hospitalizations
                           

43. Heart Failure Medications used to treat Heart Failure Potassium
Most diuretics remove potassium from the body
Potassium pills compensate for the amount lost in the urine
Potassium helps control heart rhythm and is essential for the normal work of the nervous system and muscles
                           

44. Heart Failure Treatment options Surgery and other Medical Procedures
Coronary artery bypass
Angioplasty
Valve replacement
Automated Implantable Cardioverter-Defibrillator (AICD)
Biventricular pacemaker (BiV or CRT)
Left ventricular assist device
Heart transplant
                           

45. AICD

46. AICD Monitors heart rhythm Shocks to reset rhythm Can be interrogated
Does not alter symptoms

49. Biventricular Pacemaker
Reserved for patients with symptoms despite optimal medical therapy
Conduction disease
Improves symptoms
Reduces mortality

50. Left Ventricular Assist Device

51. LVAD
Reserved for patients awaiting transplant and for patients with continued severe symptoms despite optimal therapy

52. Is There a Cure for Heart Failure?
No, currently there is no cure
But, early diagnosis and proper treatment can:
Slow the progression of disease
Keep you out of the hospital
Save your life

53. Can a Person Live with Heart Failure?
YES!
See your physician regularly
Limit your salt intake
Weigh yourself each day
Take your medications
Exercise at levels recommended by your physician

54. For More Information About Heart Failure
Visit “The Heart Failure Society of America”
Individuals –
Health Care Professionals –

55. Thank You!