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Heart Failure (HF)

Definition:

Clinical syndrome of cardiac pump dysfunction → results in congestion and low perfusion.

Dyspnea Orthopnea S3 Sound JVD

Classification

1. Left Heart Failure

• Dyspnea on exertion
• Orthopnea: SOB when lying flat
• PND: Awakening breathless
• Pulmonary edema: Fluid in alveoli
• S3 heart sound: Often present

2. Right Heart Failure

Often secondary to left HF

• Peripheral edema: Legs, sacrum
• JVD: Jugular venous distention
• Hepatomegaly: "Nutmeg liver"
• Ascites: In advanced cases
• Cor pulmonale: Isolated right HF

Systolic vs Diastolic Dysfunction

Type	EF	EDV	Primary Abnormality	Common Causes
HFrEF (Systolic)	↓	↑ or Normal	↓ Contractility	Ischemic heart disease, MI, Dilated CM
HFpEF (Diastolic)	Normal	Normal	↓ Compliance (↑ EDP)	Hypertension, Aging, Hypertrophy

Pathophysiology

1. Hemodynamic Stress → Increased preload / afterload
2. Neurohormonal Activation → RAAS, Sympathetic system → Fluid retention
3. Cardiac Remodeling → Ventricular dilation, fibrosis → Worsening HF

Key Histology:

Hemosiderin-laden macrophages in alveoli ("HF cells").

Management Principles

Mortality-Reducing Drugs

• ACE inhibitors or ARBs
• β-blockers (not in acute)
• Spironolactone

Symptom Relief

• Loop diuretics, thiazides
• Hydralazine + nitrate therapy

💡 High-Yield Clinical Pearls

• S3 heart sound: Indicates volume overload/systolic dysfunction.
• Orthopnea / PND: Due to redistribution of fluid when supine.
• Right HF: Most commonly caused by Left HF.
• Nutmeg liver: Result of chronic passive hepatic congestion.
• HFrEF vs HFpEF: Contractility issue vs Compliance issue.

❓ High-Yield Questions

1. What heart sound is characteristic of volume overload in systolic HF? Answer: S3 Heart Sound (Ventricular Gallop) Show Answer

2. What is the most common cause of Right Heart Failure? Answer: Left Heart Failure Show Answer

3. Define Cor Pulmonale. Answer: Isolated Right HF due to pulmonary disease (e.g., COPD, Pulmonary HTN) Show Answer

4. What histological finding in the lungs is indicative of chronic HF? Answer: Hemosiderin-laden macrophages ("HF cells") Show Answer

5. In which type of HF is the Ejection Fraction (EF) typically normal? Answer: Diastolic Dysfunction (HFpEF) Show Answer

6. Name three drug classes proven to reduce mortality in HFrEF. Answer: ACEi/ARBs, Beta-blockers, and Mineralocorticoid Antagonists (Spironolactone) Show Answer

7. Why does orthopnea occur in Left HF? Answer: Increased venous return when supine exacerbates pulmonary congestion Show Answer

8. What is the primary hemodynamic abnormality in HFpEF? Answer: Decreased ventricular compliance (stiff ventricle) Show Answer

9. What gross liver finding is associated with chronic passive congestion? Answer: Nutmeg liver Show Answer

10. True or False: Beta-blockers should be initiated during an acute HF decompensation. Answer: False (They are initiated once the patient is stable/euvolemic) Show Answer

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