DR.

ABDULKADIR PAEDO

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HEART FAILURE

OUTINE

Definition Pathological
principle
Epidemiology Clinical
presentation
Classification Evaluation
Etiology Investigation

DEFINITION

- HF is defined as a clinical syndrome characterized by inability of the heart to

pump sufficient blood to meet the metabolic requirement of the body despite
adequate atrial filling
o Clinical: HF is a clinical diagnosis
o Pump: the pump fxn of the heart is relative; based on requirement of the body

EPIDEMIOLOGY

- HF is responsible for
o 12% of admission to emergency in Nigeria;
o 6-19% of admission to emergency in developed world
- Etiology
o Non-cardiac causes - - - developing countries
o Cardiac causes - - - - - - developed countries
- Affects ALL AGES

CLASSIFICATION

- Based on ventricles affected:

o Biventricular HF (congestive heart failure) - - - common in children
Has a constellation of features from both Rt. and Lt. ventricular failure
o Right ventricular HF
Rarely occurs alone in children
Characterized by features of systemic venous congestion: Hepatomegaly,
ascities, peripheral edema
o Left ventricular HF
Also rarely occurs alone in children
Characterized by hypotension, pulmonary congestion (dyspnea, cough, )
- Based on the Predominant Manifestation:
o Forward dysfunction HF
Hypotension
o Backward dysfunction HF
Edema
- Based on Severity using the Modified New York Heart Association
o

ETIOLOGY

- CARDIAC CAUSES
- NON-CARDIAC CAUSES
 CARDIAC CAUSES

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CONGENITAL CARDIAC HF ACQUIRED CARDIAC HF

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Obstructive lesion - Acute Rheumatic fever and its
- Coarctation of aorta sequelae, Rheumatic heart
- Aorta stenosis disease
- Pulm. stenosis - Cardiomyopathies
- Extrinsic compression of aorta o Dilated
Shunt Lesions (commonest cause) o Hypertrophic
- VSD o Restrictive
- ASD - Infective endocarditis
- PDA - Complications of HTN of any
- TA etiology
- TGA - Myocarditis: viral, bacterial,
- TAPVR
protozaol
- Eisenmenger syndrome
- Iatrogenic as complications of
- Aortic pulm. window
procedures such as
Regurgitant Lesion
o Large A-V collection
- Epsteins Anomaly o Blalock-Taussig shunt
- Congenital Aortic Mitral o Myocardial infarction
Regurgitation - Arrhythmias esp supraventricular
Obstructive + Shunt + Regurgitant tachycardia
lesion -
- Hypoplastic left heart syndrome
NON-CARDIAC CAUSES
- Severe anemia
o commonest cause of HF in developing countries
- Acute Lower resp. tract infection
o Bronchopneumonia
o Lobar pneumonia
o Bronchiolitis
- Asphyxia = Hypoxia + Hypercapnia + mixed acidiosis
o commonest cause of HF in neonates
- others
o endocrine/metabolic
hypoglycemia
heavy metal poisoning

PATHOPHYSIOLOGY

Concepts

- Cardiac output
o CO = SV X HR
o Factors that affect CO
Preload
Afterload
Myocardial contractility
- Preload
o A.k.a. EDV (end diastolic vol.)
o Is the vol. of blood present in the ventricles at the end of ventricular diastole (or
atrial systole) or at the beginning of ventricular systole
o As EDV increases, SV increases; BUT if this happens for too long, heart becomes
overworked increased O2 demand of myocardium reduction of SV
o Frank starlings law
 As EDV increases, SV increase, until a level at which SV remains constant

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and critical pt. is reached in which stroke vol. begins to fall

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CLINICAL PRESENTATION