2. Heart Failure

3. What is Heart Failure? The heart is not pumping properly.  Usually, the heart has been weakened by an underlying condition  Blocked arteries  Heart attack  High blood pressure  Infections  Heart valve abnormalities

4.  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.

5.  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.

6.  What is Left Heart Failure?  Systolic and diastolic heart failure are treated with different types of medications.  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)

7. What is Right Heart Failure?  Usually occurs as a result of left heart failure.  Occasionally isolated right heart failure can occur due to lung disease or blood clots to the lung (pulmonary embolism).  Leads to generalized edema → e.g. ankle edema and hepatomegaly.

8. Atrial Natriuretic Peptide (ANP)  Major site of synthesis of ANP is the cardiac atria. natriuresis (Loss of sodium) diuresis (water loss).  It stimulates natriuresis (Loss of sodium) and diuresis (water loss). renin, aldosterone and vasopressin (ADH)  Inhibits the release of renin, aldosterone and vasopressin (ADH).  Causes relaxation of blood vessels.

9. Right heart failure →↑Right atrial pressure → ANP which will lead to :- 1- ↑ heart rate. 2- ↓Anti diuretic hormone (ADH),Aldosterone, and renin → ↑ urine output. 3- ↑ Atrial natriuretic peptide (ANP) → ↑ execretion of salt and water in urine. 4- ↑ Urine output.

10. ANP Cardiac atria Brain ADH Adrenal Gland Aldosterone Kidney Renin GFR Urine Natriuresis Vsaoconstrictive action of Angiotensin II Stimulation Inhibition

11.  How fast does heart failure develop?  Usually a chronic disease  The heart tries to compensate for the loss in pumping function by: 1- Developing more muscle mass. 2- Enlarging. 3- Pumping faster.

12.  What Causes Heart Failure?  Health conditions that either damage the heart or make it work too hard. 1- Coronary artery disease 2- Heart attack 3- High blood pressure 4- Abnormal heart valves 5- Heart muscle diseases (cardiomyopathy) 6- Heart inflammation (myocarditis)

13.  What Causes Heart Failure cont.? 7- Congenital heart defects 8- Severe lung disease 9- Diabetes 10- Severe anemia 11- Overactive thyroid gland (hyperthyroidism) 12- Abnormal heart rhythms

14. Coronary artery disease:- Cholesterol and fat 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.

15. Heart attack :- An artery supplying blood to the heart becomes blocked. ↓ Loss of oxygen and nutrients damages heart muscle tissue causing it to die (myocardial infarction). ↓ Remaining healthy heart muscle must pump harder to keep up.

16. 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.

17. Severe anemia:- Not enough red blood cells to carry oxygen. ↓ Heart beats faster and can become exhausted 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.

18. Signs and Symptoms of Left Heart Failure:- Shortness of Breath (dyspnea) due to → Blood “backs up” in the pulmonary veins because the left ventricle can not pump blood properly to the systemic circulation → fluid leaks into the lungs → pulmonary edema. SYMPTOMS:- Dyspnea on exertion or at rest. Difficulty in breathing when lying flat. Waking up with short of breath.

19.  Signs and Symptoms of Right Heart Failure:- Edema:- 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.

20. Signs and Symptoms of Heart Failure:- Tiredness, fatigue 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.