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Heart Failure lecture
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detailed, neat and organised lecture about heart failure. includes diagrams to aid learning.
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HEART FAILUREINRODUCTION
- Heart failure is common- 1 in 5 people will develop heart failure and a lot of people live with heart
failure.
- It’s also a cause of death
o In 2017 168 thousand people died from some sort of heart failure and circulatory disease
e.g. heart attack, stroke and heart failure (28 and a half thousand people- nearly 5% of the
total deaths).
o Cause of acute death
Heart failure
- If someone is diagnosed with heart failure, there’s a very poor long-term survival
- Predominately in people over 70 or 80 years
o 81% survive 1 year
o 52% survive 5 years
o 30% survive 10 years
- Heart failure: inability of the heart to perfuse metabolising tissues adequately
o Underlying physiological impact of heart failure
o The heart is no longer able to generate enough pressure against the resistance of the
circulatory system to allow to adequate perfusion of every tissue in the body
Heart has 4 chambers:
- Venous side / non oxygenated side: blood will
come up the vena cava or down the vena cava into
the right atria and go into the right ventricle where
the generated pressure pushes it out and around
the lungs
- Oxygenated blood: come back into the left atria,
fills the left ventricle and then goes out through
the aorta to the rest of the body.
In heart failure:
One or both ventricles generate insufficient pressure to generate the pressure around the body to allow
adequate perfusion of all tissues
One of the most frequent causes is where you have an expansive remodelling of the myocardium where
the heart is no longer shaped in a way and has sufficient contractile power to generate the pressure
required
Three reasons why the heart can begin to fail:
1) The tissue itself, the myocardium becomes TOO STIFF
o Two reasons:
~ FIBROSIS: laying down of inappropriate fibrous material in response to a heart
attack where the area of heart muscle has died and is replaced with scar tissue
~ OEDEMA: the generation of excessive fluid within the tissue that causes the tissue
to become too stiff
2) Lack of viable muscle/contraction
o Frequently due to a heart attack which causes ischaemia and myocardial death.
, o It can also happen as a consequence of viral infection where the heart muscle becomes
infected and you get cell death
o With ageing and reshaping you get a lack of viable tissue
3) Physical shape of the ventricles- MISSHAPEN- inefficient pumping
o If the ventricles become enlarged and flabby, they no longer maintain the correct shape
o Shape is essential as the action potential generates through the heart tissue, it doesn’t
cause efficient pumping
Two factors that can trigger heart failure:
1) Factors that originate in the heart- disease or pathology
2) External factors that place excessive demands on the heart
Incidence of heart failure is increasing as the population ages
- The number of people in the +50 yrs group for all
categories is higher in 2014 than in 2002
- Shows that the population is ageing- for every age
group there are more people in 2014 than there were
in 2002- underlies the fact that the UK population is
ageing~ having a higher proportion of people who are
older as time goes on.
- More people who are older and more of them have
heart failure.
- Contrast to the number of people dying prematurely
from a heart attack which has got progressively lower
over the last 30 years
- People survive with heart attacks but end up with
heart failure instead
- the social economic strata that people live in affects
the rate of heart failure
- heart failure like most cardiovascular disease follows a
socioeconomic distribution.
- the highest rates of heart failure are in the most deprived
sections of the community
- underlies the fact that this is a multi-factorial disease that
actually correlates with CVD well
- appears most frequently in the older population
- combination of lots of different factors that promote both
CVD and heart failure hand-in-hand
Why is HF increasing in prevalence?
1) Increased life expectancy and ageing of the population
2) The epidemic of cardiac and non-cardiac comorbidities
3) Increased clinical recognition of HF – as technology gets better more and more people are
diagnosed as having heart failure and possibly the sensitivity of those tests increasing, so therefore
the actual diagnosis is increasing
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