Heart FailureCase Presentation & Topic Review
By: Bushra AL Asaor, Pharm D intern, Al Maarefa college.Supervised by: Pharm D. Salah Zouein.
Mortality:
Absolute mortality rates: 50% within 5 years of diagnosis. 22% in 1-year after hospitalization. 10.4% in 30-day after hospitalization.
2013 ACCF/AHA Guideline for the Management of Heart Failure
Outline:1. Definition2. Classification3. Clinical symptoms4. Risk factors5. Body adaptation mechanism6. HF stages7. Management8. Case review
Definition: HF is a complex clinical syndrome that results from any
structural or functional impairment of ventricular filling or ejection of blood.
Heart failure develops when the heart, via an abnormality of cardiac function (detectable or not), fails to pump blood at a rate commensurate with the requirements of the metabolizing tissues or is able to do so only with an elevated diastolic filling pressure
Classifications:Description EF% ClassificationSystolic HF ≤40 HF with reduced
ejection fraction(HFrEF)
Diastolic HF 50≤ HF with preserved
ejection fraction(HFpEF)
Normal EF :55-70%
Clinical manifestation:
Risk factors: Hypertension Diabetes Mellitus Metabolic Syndrome Atherosclerotic Disease Obesity Dyslipidemia
2013 ACCF/AHA Guideline for the Management of Heart Failure
Body adaptation to heart failure:1. Cardiac Hypertrophy2. Congestion of chambers3. Activation of Renin Angiotensin Pathway4. Pulmonary (Left Side) or Systemic (Right Side) Venous Congestion.5. Dilutional Hyponatremia6. Increased Sympathetic Activity( Vasoconstriction, Tachycardia, contractility7. Endothelin release( Vasoconstriction)8. Reduced Nitric Oxide production.9. Bradycardia.
2013 ACCF/AHA Guideline for the Management of Heart Failure
Heart failure stages:
NYHA
AHA
Management:
Therapeutic alternatives: ACEi. ARB. Beta Blocker. Aldosterone antagonist. Nitrate hydralazine. Digoxin. Loop diuretic.
HF management
Stage A* Control
risk factors* ACE For MI
or DM* Statin in
dyslipidemia
Stage BICMP
+ post MI
+LVEF≤30+GFSICD
Recent or history of MI ± rEF
ACE or ARBB
blocke
r *
Structural
abnormality
without MITreat HTN
Stage C Stage D
* Effective B Blocker
in HF:Metoprol
ol SR, Bisoprolol,Carvedil
ol2013 ACCF/AHA Guideline for the Management of Heart Failure
HF management
Stage A Stage B Stage C
ACEi or ARB& BB+
Omega 3
Persistently symptomatic despite TX
+ ARBOrDigoxin
If AA add (Nitrate hydralazine)
1- EF ≤35 & crcl≥30ml/min & K<5meq/dl2- EF≤40 & acute MI & symptom or DM
Aldosterone antagonist
Volume overload
Loop diuretic
Stage D
1- Fluid restriction(1.
5-2L/d).2- Inotropes
for cardiogenic
shock3-Cardiac
transplantation.
4-Diuretic if overload.
5- IV NG or Nitroprusside if dyspnea
without hypotension.
2013 ACCF/AHA Guideline for the Management of Heart Failure