Heart Failure & Valvular Disorders

Definition: Heart failure is a syndrome resulting in insufficient blood supply and oxygen to tissues and organs due to impaired function of the heart.
Key Focus: Primarily concerning the left ventricle which is the main pump of the heart.

Blood Flow Pathway:
- Blood returns from the body to the right atrium → right ventricle → out to the lungs → back to the left atrium → left ventricle → pumped out to the body.
Valves: Importance of understanding heart valves in relation to blood flow.
Chambers of the Heart to Know: Left atrium, left ventricle, right atrium, right ventricle.

Diastolic Heart Failure:
- Problem during diastole (resting phase of the heart) where the heart cannot fill properly due to stiffness.
Systolic Heart Failure:
- Problem during systole (contracting phase of the heart) where the heart muscle is weak and cannot pump effectively.

Definition: Ejection fraction (EF) is the percentage of blood that is pumped out of the left ventricle with each heartbeat.
Normal Range: Generally accepted as 50% to 55%, with some considering as low as 45% still acceptable.
Clinical Significance: Indicates how well the heart is pumping blood; important in diagnosing heart failure severity.

Main Risk Factors:
- Hypertension
- Coronary artery disease (CAD)
- Diabetes
- Increasing age
- Tobacco use
- Valvular disorders
Common Causes:
- Coronary artery disease and hypertension are primary causes.
- Other factors include obesity and sedentary lifestyle.

Functionality: Caused by:
- Inability to empty during systole (systolic failure)
- Inability to fill during diastole (diastolic failure)
Consequences of Left-Sided Heart Failure:
- Blood backs up into the left atrium and pulmonary veins, leading to pulmonary congestion, increased pressure in lungs, and pulmonary edema.
Clinical Symptoms:
- Dyspnea (shortness of breath)
- Orthopnea (difficulty breathing while lying flat)
- Paroxysmal nocturnal dyspnea (night-time breathlessness)
- Cough with pink, frothy sputum (indicative of pulmonary congestion).

Functionality: Occurs when the right ventricle fails to pump effectively.
Consequences:
- Blood backs up into the right atrium and can lead to peripheral congestion and edema.
Clinical Symptoms:
- Pedal edema, ascites (fluid in the abdomen), hepatomegaly, increased jugular venous distention (JVD).

Clinical Manifestations:
- Stages 1-4 (1 being mild, 4 being severe requiring transplant).
- Use classifications A, B, C, D for heart failure.
S3 and S4 Heart Sounds:
- S3: Indicates volume overload, associated with heart failure.
- S4: Stiff heart wall, associated with hypertensive heart disease.

Acute Decompensated Heart Failure:
- Sudden worsening of signs and symptoms, requiring immediate medical attention. Symptoms include severe shortness of breath, crackles in lungs, and urgent care is necessary.
Chronic Heart Failure:
- Ongoing problem, lifelong management required. Fatigue, chronic shortness of breath, and other signs of heart failure persist over time.

Echocardiogram: Best tool for assessing heart function, including ejection fraction and valve health.
BNP Levels: B-type natriuretic peptide (BNP) levels; normal is <100 pg/mL, elevated levels indicate heart failure.
Chest X-ray: Can show fluid in lungs or enlarged heart.
EKG/ECG: Assess for rhythm abnormalities.
MUGA Scan: Provides information on ejection fraction.

Medications:
- Diuretics (to reduce fluid overload)
- ACE inhibitors (decrease preload and afterload)
- Beta blockers (to slow heart rate and lower blood pressure)
- Positive inotropes (to improve heart contractility)
Lifestyle Changes:
- Low-sodium diet (typically <2g/day)
- Fluid restrictions (varies by patient)
- Weight monitoring to detect fluid retention.

Definition: Disease of the heart muscle characterized by cardiac dysfunction. Types include:
- Dilated Cardiomyopathy (most common, enlarged chambers)
- Hypertrophic Cardiomyopathy (thickened walls)
- Restrictive Cardiomyopathy (rigid walls).
Symptoms: Similar to heart failure and include fatigue, breathlessness, and fluid retention. Risk of sudden cardiac arrest especially in young athletes.

Types of Valvular Disease:
- Stenosis: Narrowing of the valve, limits blood flow (e.g., aortic stenosis).
- Regurgitation: Improper closing of valve, allows backward flow (e.g., mitral regurgitation).
- Prolapse: Valve leaflets bulge backward during heart contraction.
Management: Treatment often mirrors that of heart failure, and severe cases may require valve repair or replacement.

Definition: Infection of the inner lining of the heart, often involves the valves. Caused primarily by bacteria (staph or strep).
Clinical Signs: Symptoms include fever, malaise, and new heart murmurs, as well as embolic phenomena (e.g., Janeway lesions).
Diagnosis and Treatment: Blood cultures, echocardiograms to detect vegetations; usually treated with prolonged IV antibiotics.

Pericarditis: Inflammation of the pericardium, presents with sharp chest pain and friction rub upon auscultation.
Pericardial Effusion: Accumulation of fluid, can lead to cardiac tamponade (emergency situation requiring drainage).
Myocarditis: Inflammation of the myocardium, often self-limiting but may lead to heart failure if severe.

Understanding heart failure, its causes, types, diagnostics, treatment, and associated conditions is crucial for effective patient care. Management involves a combination of lifestyle changes, medications, and potentially surgical interventions depending on the severity of the condition and patient response.