Heart Failure

Clinical syndrome characterised by dyspnea, effort intolerance, orthopnea, PND, nocturnal cough and oedema. Other symptoms include early satiety, N+V, abdo discomfort, wheezing, coughing, fatigue.

Signs:
- Elevated cardiac filling pressures and fluid overload
- Cardiac enlargement
- Reduced cardiac output
- Arrhythmia

NYHA classification
Class I                 No limitation on physical activity
Class II                Slight limitation on physical activity
Class III               Marked limitation on physical activity
- IIIa - symptoms with less than ordinary activity
- IIIb - symptoms with minimal exertion
Class IV              Unable to carry on any physical activity without symptoms

Medical Rx:

• ACE inhibitors
• Angiotensin receptor blockers
• Beta blockers
• Aldosterone antagonists
• Other vasodilators - hydralazine and isosorbide dinitrate

HF with preserved Ejection Fraction (HFPEF)
Often associated with uncontrolled HTN
RFs include older age, female, HTN, obesity, DM, CAD, CKD
Rx: ACE (perindopril), Beta blockers (Nebivolol), ARB (Candesartan, Irbesartan)

Biventricular Pacing (CRT) indications:
All of the following:

• NYHA class III or IV
• EF <= 35%
• Ventricular dyssynchroniy (QRS>= 120msec)

Aim is to restore myocardial electromechanical coupling and effective ventricular contraction
Combined ICD and CRT devices can be placed