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