1. Heart Failure Definition: It represents the failure of the heart to supply adequate blood flow and, hence, nutrients and oxygen to metabolizing tissues

2. Types of heart failure 1. High output vs low output failure: ► High output heart failure in: AnaemiaHyperthyroidism ► Low output failure in: HypertensionCHDCardiomyopathies

3. 2. Right-sided vs left-sided heart failure Important causes of left and right heart failure: * Left heart failure: 1. Ischaemic heart disease 2. Rheumatic heart disease (MR – AS - AR) 3. Hypertension 4. Cardiomyopathy 5. Congenital heart disease ( VSD – PDA)

4. * Right heart failure: 1. Secondary to lung disease 2. Multiple pulmonary emboli 3. Rheumatic tricuspid valve disease (rarely) 4. Congenital heart disease (ASD – Any cyanotic heart disease with right to left shunt)

5. ► Congestive heart failure (right heart failure 2ry to left heart failure) must be distinguished from cor- pulmonale ( right heart failure 2ry to lung disease) ► The symptoms and signs in these 2 conditions can be very similar, and the 2 may co-exist.

6. Symptoms and signs of left heart failure ► Dyspnea ► Orthopnea ► Paroxysmal nocturnal dyspnea ► Signs of pulmonary congestion (basal lung crepitations – pink frothy sputum) ► Cardiac asthma (wheezy chest) ► Pulmonary oedema (Bubbling crepitations)

7. Symptoms and signs of right heart failure ► Congested neck veins ► Hepatomegaly (tender enlarged liver – dyspepsia) ► Peripheral oedema ► Pleural effusion & ascites in advanced cases