Guidelines on management of Heart Failure

Dr. Muhammad Arslan

In accordance with

Definition of HF“HF is a complex clinical syndrome that results from

any structural or functional impairment of ventricular filling or ejection of blood.”

Manifestations of HF

The cardinal manifestations of HF are dyspnea and fatigue, which may limit exercise tolerance, and fluid retention, which may lead to pulmonary and/or splanchnic congestion and/or peripheral edema.

Because some patients present without signs or symptoms of volume overload, the term “heart failure” is preferred over

“congestive heart failure.”

Some patients have exercise intolerance but little evidence of fluid retention, whereas others complain primarily of edema, dyspnea,

or fatigue.

CLASSIFICATIONOf Heart Failure

On the Basis ofEjection Fraction

HF With Reduced EF (HFrEF)also referred to as Systolic HF

• HFrEF is defined as the clinical diagnosis of HF AND EF ≤40%.

• In approximately half of patients with HFrEF, variable degrees of LV enlargement may accompany HFrEF.

• Coronary artery disease (CAD) with antecedent myocardial infarction (MI) is the major cause of HFrEF. Risk factors are Hypertension, Diabetes, Metabolic syndrome and atherosclerosis.

Other causes are:• Dilated Cardiomyopathy– Idiopathic– Familial

• Metabolic Cardiomyopathies– Obesity Cardiomyopathy– Diabetic Cardiomyopathy– Thyroid disorders– GH disorders

• Toxic Cardiomyopathies– Alcoholic Cardiomyopathy– Cocaine Cardiomyopathy

• Tachycardia Induced Cardiomyopathy

• Infectious Cardiomyopathy• Myocarditis• AIDS• Chaga’s disease

• Inflammatory Cardiomyopathy• Hypersensitivity• Rheumatlogical

• Peripartum Cardiomyopathy• Amyloidosis• Sarcoidosis• Iron Overload• Stress Cardiomyopathy

HF with Preserved EF (HFpEF)also referred to as Diastolic HF

• Criteria proposed to define the syndrome of HFpEF include (a) clinical signs or symptoms of HF(b) evidence of normal or preserved LVEF (≥50%)(c) evidence of abnormal LV diastolic dysfunction

that can be determined by Doppler echocardiography or cardiac catheterization

(a) Hypertension is the major causative factor.

a. HFpEF, borderline EF: 41 to 49 %

These patients fall into a borderline or intermediate group. Their characteristics, treatment patterns, and outcomes

appear similar to those of patients with HFpEF.

b. HFpEF, improved EF: >40%A subset of patients with HFpEF previously had HFrEF. These patients with improvement or recovery in EF may be clinically distinct from those with persistently preserved or reduced EF. Further research is needed to better characterize these patients.

of Heart Failure

FUNCTIONALCLASSIFICATION

of Heart Failure

STAGES

Comparing FUNCTIONAL Classification with STAGES