Overview and Introduction
• This course is an introduction and overview of heart
failure. Normal heart function and basic pathophysiology
of heart failure is explained. This will be then related to
the diagnosis of heart failure and to the overall
management of patients with heart failure. Device therapy
will be explained, and also finally we will have discussion
session about palliative care and heart failure.
Demographics of heart failure
• Heart failure is serious
• Heart failure is terminal
• Heart failure is unpredictable
• Heart failure causes severe symptoms
• Heart failure outcomes are directly linked to good
management and self monitoring.
You can make a profound difference to a patient’s life
Plan of the Day
• The normal heart
• Pathophysiology of heart failure
• Clinical presentation: History, assessment and clinical
examination
• Differential diagnosis, Investigations and Diagnosis
• Pharmacological Management
• Non medical Management
• Palliative care
• Device therapy
1. Normal Heart Function
• The Cardiac Circulation
• The Cardiac Valves
• The Coronary Circulation
• The Cardiac Electrical System
The Normal Heart
• https://www.youtube.com/watch?v=H04d3rJCLCE&featur
e=player_detailpage
• http://www.cardiachealth.org/how-does-your-heart-work-
anatomy-heart-coronary-arteries
2. Pathophysiology of heart failure
The two types of heart failure affecting the left ventricle.
• HFrEF – can’t pump
• HFPEF – can’t relax
Other causes include:
• Mitral regurgitation
• Atrial fibrillation
• Cardiomyopathies
• Chemotherapy …….
2. Pathophysiology of heart failure
Neurohormonal Activation
1. Increased Sympathetic activation
1. Reduction in renal perfusion results in activation of the
RAAs
Its Systemic
• Fatigue
• Cool extremities
• Pallor
• Heavy leaden legs
• Renal dysfunction
• Anaemia
• Acute/increasing breathlessness
• Presents/punctuated with unpredictable episodes of fluid
retention…..
3. Clinical Presentation
Signs of Heart Failure
- General Appearance – distress, gait, mobility, colour, pallor,
tachypnoea, breathlessness, audible breath sounds,habitus,
• Tachycardia/irregular
• Hypertension/hypotension
• Pallor/mallor flush
• Elevated JVP (>5cm)
• Heart Sounds – third heart sound
• Added Breath Sounds – Crepitations/wheeze
• Abdominal distension
• Oedema – legs/sacral
???
Is it ?
• Chest
infection/pneumonia?
• Pulmonary Embolism?
• COPD?
• N/AFLD?
• Obesity?
• Reduced Venous Return?
• Lymphoedema?
Or is it?
• Heart Failure?
Investigations
• BNP
• ECHO
• ECG
• CXR
• Holter monitor
• 24hour BP
• Also Cardiac MR, MPS, Angiography
Other Pharmacological agents and
contraindications • Digoxin
• Oral Anticoagulations – NOACS
• Ivabradine
• Antianginals
• Antihypertensives
• Palliative Medications
• Contraindications
Non Pharmacological Management
• Anxiety/stress management
• Depression/low mood
• Support Groups
• Telehealth
• Salt intake
• Fluid intake
• Dry mouth
Non Pharmacological Management
• Exercise
• General weight management
• Smoking, alcohol
• Fatigue management – goal setting
• Sleep
• Caffeine intake
• Vaccinations
• Holidays