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Cardiac Failure (Heart Failure)

Background Knowledge ๐Ÿง 

Definition

  • A clinical syndrome where the heart is unable to pump blood at a rate commensurate with the requirements of the metabolising tissues, or can only do so with an elevated filling pressure.

Classification

  • Systolic: Impaired ejection (commonly reduced ejection fraction).
  • Diastolic: Impaired filling (normal ejection fraction but reduced compliance).
  • Based on presentation: Acute vs. Chronic.
  • Based on side of heart affected: Left, right, or biventricular failure.

Pathophysiology

  • Reduced cardiac output โ†’ Activation of renin-angiotensin-aldosterone system & sympathetic nervous system โ†’ Fluid retention & vasoconstriction โ†’ Worsens cardiac workload.

Aetiology/Risk Factors

  • Primary cardiac: Ischaemic heart disease, hypertension, valvular heart disease, cardiomyopathies.
  • Systemic: Thyroid disease, anaemia, high output states, chronic kidney disease.
  • Toxins/Drugs: Alcohol, chemotherapy, cocaine use.
  • Others: Infections (e.g., myocarditis), arrhythmias, constrictive pericarditis.

Clinical Features ๐ŸŒก๏ธ

Clinical Features

  • Left-Sided Failure: Dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, pulmonary oedema.
  • Right-Sided Failure: Peripheral oedema, ascites, hepatic congestion, raised jugular venous pressure (JVP).
  • General: Fatigue, palpitations, reduced exercise tolerance.

Investigations ๐Ÿงช

Investigations

  • ECG: May show signs of underlying cause (e.g., ischaemia, arrhythmia).
  • Chest X-ray: Cardiomegaly, pulmonary congestion, pleural effusion.
  • Echocardiography: Assess chamber sizes, function, and valvular abnormalities.
  • Bloods: NT-proBNP, electrolytes, renal function, liver function, thyroid function.

Management ๐Ÿฅผ

Management

  • Lifestyle: Salt & fluid restriction, smoking cessation, weight management, exercise.
  • Pharmacotherapy: Diuretics, ACE inhibitors/ARBs, beta-blockers, mineralocorticoid receptor antagonists, digoxin.
  • Devices: Implantable cardioverter-defibrillator (ICD), cardiac resynchronisation therapy (CRT).
  • Severe cases: Left ventricular assist device (LVAD), heart transplantation.

Prognosis

  • Prognosis is generally poor.
  • Approximately 50% of patients with heart failure die within 5 years of the diagnosis.

Complications

  • Cardiogenic shock
  • Arrhythmias
  • Thromboembolism (e.g., stroke)
  • Cardiac cachexia

Key Points

  • Cardiac failure is a complex clinical syndrome with various underlying causes and presentations.
  • Early diagnosis and intervention can improve the quality of life and prognosis.Management is multifaceted and tailored to the patient’s needs and underlying aetiology.

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