Heart failure classification, risk factors and precipitating events

Heart failure:Clinical syndrome that occurs in patients due to any STRUCTURAL OR FUNCTIONAL CARDIAC DISORDER, so that patient develop a constellation of symptoms (DYSPNOEA and FATIGUE) and signs (OEDEMA and RALES) which lead to frequent hospitalizations, poor quality of life and a shortened life expectancy. It is the end result of various disease of heart. In cardiac failure heart fails to maintain an adequate blood supply to meet the metabolic demand of body. In mild to moderate disease heart maintain adequate cardiac output at rest but cant meet the increased demand such as exercise. Prevalence of heart failure increases with age. It carries a poor prognosis. Sudden death can occur due to malignant ventricular arrythmias or heart attack. Coronary artery disease is the leading cause of heart failure in western world.

Nyha classification.

Class I : Patients with cardiac disease but no limitation of physical activity; there are no symptoms from ordinary activities.

Class II : Slight limitation of physical activity; the patient is comfortable at rest.

Class III : Marked limitation of physical activity; the patient is comfortable only at rest.

Class IV : Any physical activity brings on discomfort and symptoms occur even at rest.

Following are the risk factors of heart failure

1. Coronary artery disease.
2. Hypertension.
3. Diabetes Mellitus.
4. Dilated and Hypertrophic cardiomyopathy.
5. Valvular heart disease.
6. Cigarette smoking.
7. Alcohol intake.
8. High output failure - Anaemia, thyrotoxicosis, arteriovenous fistulae,Paget’s disease
9. Pericardial disease - Constrictive pericarditis,Pericardial effusion
10. Primary right heart failure- Pulmonary hypertension

Preecipitating or aggrevating factor are those increases the oxygen demand of body.

Preecipitating factors

1. Myocardial ischemia or heart attack.
2. Infection.
3. Arrythmia.
4. Increased salt intake.
5. Non compliance with anti CHF medications.
6. Acute myocardial infarction.
7. Aggravation of Hypertension.
8. Administration of drugs with negative ionotropic properties(beta blockers) or fluid retaining properties(NSAIDS, steroids).
9. Pulmonary embolism.
10. Conditions associated with increased metabolic demand - Pregnancy, thyrotoxicosis, anemia.
11. Intravenous fluid overload – post operative iv infusion.
12. Rheumatic, Viral, and Other Forms of Myocarditis.
13. Infective Endocarditis.
14. Physical, Environmental, and Emotional Excesses.