 What is heart failure? Heart failure is a pump dysfunction. It leads us to congestion and to low perfusion of the body from the heart the symptoms associated with heart failure include dyspnea or shortness of breath or Thopnea or shortness of breath while laying down and then fatigue obviously. We're not perfusing all of the body to be able to Produce that energy needed So we're gonna have fatigue Signs associated with heart failure include a S3 heart sound right after S2 during diastole rails jugular venous distention or pitting edema that edema can be Swelling in the legs or ankles as you see in this picture over here It could also be swelling in the upper portions of the body such as swelling in the abdomen like asides Or we could even see some pleural effusions due to excess fluid being promoted around the lungs You see pitting edema in this photo basically pitting edema is often seen in the most dependent portions of the body in the lower legs and If you take your finger and you press against the tibial bone on Patient that has pitting edema and you remove your finger after a couple of seconds you will see these pits that are remaining in the skin there and that is a sign of pitting edema and a Issue with heart failure So we have a couple different things that can be associated with heart failure We can have systolic dysfunction where we have a reduced ejection fraction Our end diastolic volume is going to be increased because we're not pumping as much out and then our contractility will be decreased often secondary to ischemia Continuing on to potentially a myocardial infarction or dilated cardiomyopathy We can see a diastolic dysfunction where we have a preserved ejection fraction So our heart is still able to pump out the correct amount of fluid or cardiac output And we can have a normal end diastolic volume as well. What we will see is a decrease in compliance And what will that do with our end diastolic pressures? That'll increase our end diastolic pressures That will be oftentimes secondary to a myocardial hypertrophy So we're preserving the amount we're pushing out and having a normal end diastolic volume But our pressures are higher due to our decrease in compliance oftentimes Right heart failure is associated or a result of left heart failure so the left heart failing Causes a backup of blood into the lungs can cause pulmonary congestion And then push back into the right side of the heart leading to right-sided heart failure We treat any type of heart failure with an ace or an arb So an ace inhibitor or an angiotensin receptor blocker. We also can use beta blockers. However Beta blockers are contraindicated with patients that are in acute decompensated heart failure and Then finally we can use spironolactone spironolactone has actually been found to decrease mortality in these patients We can also add on loop or thiazide diuretics But these are mostly used for symptomatic relief. They don't typically show much improvement in Mortality, so using loops or thiazides is only going to be more for a symptomatic relief for the patient Let's walk through this chart together to see some of the downstream effects of The beginnings of heart failure. So like we said left ventricular heart failure is typically the first and most common type of heart failure and What's happening is we're having a decrease in contractility of the left ventricle So moving straight down this chart that leads to a backup Like I said into the pulmonary side of things and we get pulmonary venous congestion that can In turn lead us to a pulmonary edema That backup into the lungs can then continue and back up into the right side of the heart And that will decrease our right ventricular output leading us to peripheral edema Following the right arrow our decrease in contractility will then in turn decrease the cardiac output Which will then activate the feedback loop of the renin angiotensin aldosterone system Causing an increase in the renal sodium and water reabsorption because the body thinks that there's not enough fluids So we're going to reabsorb all these fluids in the kidneys We'll increase our systemic venous pressure even though we don't need that much fluid Because what the problem isn't that we're low on fluid the problem is we're not pumping it well So the increase in systemic venous pressure that we don't need then we'll push us over to more peripheral edema And it also will push us down to an increase in the preload on the heart Increasing our preload on the right side of the heart will in turn increase our cardiac output and that is what is known as cardiac Compensation so the body is compensating for the low blood flow by increasing the blood flow back to the heart to try and make more blood flow one further pathway is Due to that decrease in cardiac output We see an increase in sympathetic activity that increase in sympathetic activity will increase our left ventricular Contractility which will then also lead to an increase in our cardiac output Once again furthering our compensation from that decrease of the left ventricular contractility So some of the symptoms associated with left heart failure include Orthopnea which is due to an increase in the venous return from the redistribution of blood Paroxysmal nocturnal dyspnea, this is a breathlessness when awakening from sleep And that's due to an increase in the venous return a resorption of the peripheral edema And then as we discussed we see an increase in pulmonary edema This being due to an increase in the pulmonary venous pressure So we see pulmonary venous distention and transudate of the fluid You can see signs of pulmonary edema in a chest x-ray through what is known as curly B lines And the curly B lines are these Lines of edema that you can see stretching out in a chest x-ray and they extend out towards the periphery Just like that Right heart failure symptoms include hepatomegaly So because the right heart is backing up we're having an increase in our central venous pressure That increased increase in our central venous pressure leads to an increased resistance in the portal flow We also can see jugular venous distention and you can see that here with these veins that are popping out of the neck of this patient And that's just due to a decrease in the amount of blood that can go back into the right side of the heart And then finally we can see peripheral edema, which is a transudative fluid that is setting in the peripheral vascular system specifically And most commonly the gravity dependent areas of the body