—Prevalence
—Affects nearly 5 million Americans currently,
>500,000 new cases diagnosed each year
—Cost
—Annual direct cost in >10 billion dollars
—Incidence
increased with age
—Effects 1-2% of patient from 50-59-years-old and 10% of
patient over the age of 75
—Frequency
—It is the most common inpatient diagnosis in the US for
patients over 65 years of age
—Visits to their family practitioner on average 2-3 times
per year
—Gender
—Men> women in those between 40 and 75 years of age
—The sexes are equal over 75 years of age
Systolic
Dysfunction (Decreased Contractility)
— Reduction in muscle
mass (e.g., myocardial infarction)
— Dilated cardiomyopathies
— Ventricular
hypertrophy
— Pressure overload
(e.g., systemic or pulmonary hypertension,
—aortic or pulmonic valve stenosis)
— Volume overload
(e.g., valvular regurgitation,
shunts, high-output states)
—Diastolic
Dysfunction (Restriction in Ventricular Filling)
— Increased
ventricular stiffness
— Ventricular
hypertrophy (e.g., hypertrophic cardiomyopathy,
—other examples above)
— Infiltrative
myocardial diseases (e.g., amyloidosis, sarcoidosis,
—endomyocardial fibrosis)
— Myocardial ischemia
and infarction
— Mitral or tricuspid
valve stenosis
— Pericardial disease
(e.g., pericarditis, pericardial tamponade)
Pathophysiology of Heart Failure
—Hemodynamic Model
—Neurohumoral Adaptations
—“double-edged swords”
—Renin-Angiotensin-Aldosterone System
—Sympathetic Nervous System
—Antidiuretic Hormone
—Atrial and B-type Natriuretic Peptides
—Endothelin
Clinical
Presentation
—Asymtomatic to cardiogenic shock
Primary symptoms :
—Dyspnea (particularly on excertion)
—fatique
—Exercise intolerance
—
Pulmonary symptoms :
—Orthopnea
— Paroxysmal nocturnal
dyspnea
—Tachypnea
— Cough
—
—Fluid overload
