EXAMING HEART FAILURE: HOW TO RECOGNIZE AND TREAT THE WEAK HEART What is Heart Failure? Treatment of Heart Failure End Stage Heart Failure Munir S. Janmohamed M.D. FACC Assistant Clinical Professor of Medicine Director, Heart Failure Outreach Department of Medicine, Division of Cardiology Advanced Heart Failure/Transplant Program UCSF Objectives Heart 101 What is Heart Failure? Types of Heart Failure How common is HF? Sign/Symptoms, when to see a doctor? Diagnostic testing 1
What is Heart Failure What is Heart Failure? Definition: Heart Failure or congestive heart failure (CHF) is a condition in which the heart is unable to pump adequate blood to meet the needs of the organs of the body Types of Left Heart Failure Diastolic (or relaxation) heart failure Thick Muscle Heart does not fill with blood properly This results in fluid backup in the lungs and heart failure Systolic (or squeezing) heart failure Decreased pumping function of the heart, which results in fluid back up in the lungs and heart failure 2
Risk Factors/Causes for Heart Failure Risk Factors for Heart Failure Coronary Artery Disease Myocardial Infarction MCC CAD=coronary artery disease; LVH=left ventricular hypertrophy. Causes for Heart Failure CAD MI (Heart Attack) Hypertension (LVH) Valvular heart disease Cardiomyopathy Alcoholism Drugs (METH) Thyroid disorders Infection (viral) Diabetes Abnormal Heart Rhythm Congenital heart defects Other: Obesity Age Smoking High or low hematocrit level Obstructive Sleep Apnea Epidemiology of Heart Failure in the US Heart Failure Patients in US (Millions) 12 10 8 6 4 2 0 3.5 4.7 10 1991 2000 2037* More deaths from heart failure than from all forms of cancer combined 550,000 new cases/year 4.7 million symptomatic patients; estimated 10 million in 2037 CAD=coronary artery disease; LVH=left ventricular hypertrophy. *Rich M. J Am Geriatric Soc. 1997;45:968 974. American Heart Association. 2001 Heart and Stroke Statistical Update. 2000. 3
Increasing Heart Failure Prevalence Cardiovascular Mortality (800,000/yr) 14% 4% Mean age at diagnosis: 74 years 60% over age 75 6% 7% 52% Coronary Heart Disease Stroke Congestive Heart Failure High Blood Pressure Diseases of the Arteries 17% 280,000 deaths/yr with primary or underlying Rheumatic Fever/Rheumatic Heart Disease Go AS et al. Circulation. 2014; 129: e28-e292. Go AS et al. Circulation. 2014; 129: e28-e292. Heart Failure Care is Expensive Drugs/Medical Durables ($5 billion) 10% Physicians/Other Providers ($3 billion) 7% Hospital /Nursing Homes ($26 billion) 73% Classifying Heart Failure: Terminology and Staging Home Health ($3 billion) 10% Total Direct Costs: $31 billion in 2012 ---> $70 billion in 2030 Go AS et al. Circulation. 2014; 129: e28-e292. 4
Classification of HF: Comparison Between ACC/AHA HF Stage and NYHA Functional Class ACC/AHA HF Stage 1 NYHA Functional Class 2 A At high risk for heart failure but without structural heart disease or symptoms of heart failure (eg, patients with hypertension or coronary artery disease) B Structural heart disease but without symptoms of heart failure I None Asymptomatic C Structural heart disease with prior or current symptoms of heart failure II Symptomatic with moderate exertion III Symptomatic with minimal exertion D Refractory heart failure requiring specialized interventions IV Symptomatic at rest 1 Hunt SA et al. J Am Coll Cardiol. 2001;38:2101 2113. 2 New York Heart Association/Little Brown and Company, 1964. Adapted from: Farrell MH et al. JAMA. 2002;287:890 897. When to see a Doctor? Sign/Symptoms 5
How Heart Failure Is Diagnosed Labs Medical history is taken to reveal symptoms Physical exam is done Common Blood Tests: CBC Chemistry Panel Urine Tests BNP TSH HIV Iron Studies Testing for specific patients HIV Iron Sleep Study Protein (Light Chains) Genetic screening EKG Normal CXR CHF 6
ECHO: Gold Standard A Key Indicator for Diagnosing Heart Failure Normal Heart Function Systolic Heart Failure Ejection Fraction (EF) is the percentage of blood that is pumped out of your heart during each beat Important objective criteria in evaluating cardiac function Reflects strength of ventricular contraction Imaging CAD Evaluation MRI Nuclear Imaging 7
Summary Disorder of the Heart Prevention SS: Symptoms related to congestion/decrease output Diagnosis: ECHO 8