Lecture 19: Heart Failure3.25.08Louise [email protected]: Treatment of Heart Disease• Burden of cardiovascular disease (CVD)• Cardiovascular system• Measuring cardiovascular health• Valve diseases• Atherosclerosis/CAD and treatments–Stroke– Heart attack• Heart failure and treatmentsFrom Last Time• Burden of cardiovascular disease (CVD)• Cardiovascular system• Measuring cardiovascular health• Valve diseases• Atherosclerosis/CAD and treatments–Stroke– Heart attack• Heart failure and treatmentsReview of Last Time• How do we treat coronary artery disease?– Thrombolytic drugs• Only a small fraction of patients qualify– Percutaneous transluminal coronary angioplasty •PTCA– Stent– Coronary artery bypassgraft• CABG– PreventionPrevention vs. Treatment• Risk Factors for Heart Disease– Tobacco use– High blood pressure • Over 70% not under control– High cholesterol• Over 80% not under control – Inappropriate diet– Obesity– Low levels of physical activity• Super Size MeProgression of Heart DiseaseHigh Blood PressureHigh Cholesterol LevelsAtherosclerosisIschemiaHeart AttackHeart FailureBurden of CVDhttp://www.pbs.org/secondopinion/episodes/heartfailure/http://www.pbs.org/wgbh/nova/heart/ Heart Failure• Heart failure:– Occurs when left or right ventricle loses the ability to keep up with amount of blood flow – Can involve the heart's left side, right side or both sides– Usually affects the left side first• About 5 million Americans are living with heart failure• 550,000 new cases diagnosed each year Quantifying Heart Performance• Ejection Fraction (EF)– Fraction of blood pumped out of ventricle relative to total volume (at end diastole)– EF = SV/EDV– Normal value > 60%– Measured using echocardiographyLeft Sided Heart Failure• Involves left ventricle• Systolic failure – Left ventricle loses ability to contract– Can't push enough blood into circulation • Diastolic failure– Ventricle loses ability to relax; muscle has become stiff– Can't properly fill during resting period between beats• Pulmonary edema – Blood coming into left chamber from lungs "backs up," causing fluid to leak into the lungs– As ability to pump decreases, blood flow slows, causing fluid to build up in tissues throughout body (edema) • Congestive Heart FailureSymptoms of Heart FailureSymptomSymptomWhy It HappensWhy It HappensPeople May Experience:People May Experience:Shortness of Shortness of breath (also breath (also called called dyspneadyspnea))Blood "backs up" in Blood "backs up" in pulmonary veins (the pulmonary veins (the vessels that return blood vessels that return blood from the lungs to the from the lungs to the heart) because the heart heart) because the heart can't keep up with the can't keep up with the supply. Causes fluid to supply. Causes fluid to leak into lungsleak into lungsBreathlessness during activity, Breathlessness during activity, at rest, or while sleeping, which at rest, or while sleeping, which may come on suddenly and may come on suddenly and wake them up. Often have wake them up. Often have difficulty breathing while lying difficulty breathing while lying flat; may need to prop up upper flat; may need to prop up upper body and head on pillowsbody and head on pillowsPersistent Persistent coughing or coughing or wheezingwheezingFluid builds up in lungsFluid builds up in lungsCoughing that produces white Coughing that produces white or pink bloodor pink blood--tinged phlegm. tinged phlegm. Buildup of Buildup of excess fluid in excess fluid in body tissues body tissues (edema)(edema)As flow out of heart slows, As flow out of heart slows, blood returning to heart blood returning to heart through veins backs up, through veins backs up, causing fluid build up in causing fluid build up in tissues. tissues. Swelling in feet, ankles, legs or Swelling in feet, ankles, legs or abdomen or weight gain. May abdomen or weight gain. May find that shoes feel tightfind that shoes feel tightSymptoms of Heart FailureSymptomSymptomWhy It HappensWhy It HappensPeople May Experience:People May Experience:Increased Increased heart rateheart rateTo "make up for" loss in To "make up for" loss in pumping capacity, heart pumping capacity, heart beats fasterbeats fasterHeart palpitations, which feel Heart palpitations, which feel like the heart is racing or like the heart is racing or throbbing.throbbing.Confusion, Confusion, impaired impaired thinkingthinkingChanging levels of blood Changing levels of blood substances, such as substances, such as sodium, can cause sodium, can cause confusion confusion Memory loss and feelings of Memory loss and feelings of disorientation.disorientation.Lack of Lack of appetite, appetite, nauseanauseaDigestive system receives Digestive system receives less blood, causing less blood, causing problems with digestionproblems with digestionFeeling of being full or sick to Feeling of being full or sick to their stomach.their stomach.Tiredness, Tiredness, fatiguefatigueHeart can't pump enough Heart can't pump enough blood to meet needs of blood to meet needs of tissues. Body diverts tissues. Body diverts blood away from less vital blood away from less vital organs (limb muscles) and organs (limb muscles) and sends it to heart & brain.sends it to heart & brain.Tired feeling all the time and Tired feeling all the time and difficulty with everyday difficulty with everyday activities, such as shopping, activities, such as shopping, climbing stairs, carrying climbing stairs, carrying groceries or walking. groceries or walking. How Do We Treat Heart Failure?• Heart Transplant• Cardiac Assist Devices• Artificial Heart• Diet modification– Weight loss– Salt intake• Moderate exercise• Medicationhttp://www.cbsnews.com/htdocs/health/heart/framesource.htmlhttp://video.google.com/videoplay?docid=-7504680635958708617&q=heart+failure+duration%3Ashort&hl=enHow Do We Treat Heart Failure?• Balance a lot of issues– Prevent disease progress – Cause of heart failure• Can it be reversed?– Prognosis–Cost• SC Heart Hospital’s IT solutionhttp://video.google.com/videoplay?docid=-6557199641577284256&q=heart+failure&hl=enStages of Heart FailureStageDescription Typical TherapiesANo diagnosis or symptoms of heart failure, but the risk is high because of: hypertension; diabetes; CAD/MI; cardiotoxicdrugs or alcohol abuse; rheumatic fever; family history of cardiomyopathyStop
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