CHF

                 A.      DEFINITION

CHF is a complex clinical syndrome caharacterized by dysfunction of the left-right or both ventricles and changes in neurohumoral regulation

                 B.      DEFINITION OF HEART FAILURE

Heart failure is the pathophysiological state in which the heart is unable to pump blood at a rate commensurate with the requirements of the metabolizing tissues or can do so only from an elevated filling pressure.

Heart failure is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of ventricle to fill with or eject blood.

                 C.      SYMPTOMPS AND SIGN

1.      Shortness of Breath / Dyspnea on Exertion

2.      Paroxysmal Nocturnal Dyspnea

3.      Orthopnea

4.      Non – Productive Cough

5.      Fatigue & Weakness

6.      Nocturia & Oligouria

7.      Cerebral Symptoms

8.      Abdominal Symptoms

                 D.      TYPES OF HEART FAILUR

1.      Chronic vs Acute HF

2.      Left vs Right – sided HF

3.      High Output vs Low Output HF

4.      Backward vs Forward HF

5.      Diastolic vs Sistolic HF

                  E.      EPIDEMIOLOGY

1.      Morbidity and Mortality rates remain high.

2.      USA : estimated more than 2 million patient.

3.      400.000 new patient each year.

4.      900.000 required hospitalization.

5.      200.000 patient die/year.

6.      Annual mortality rate : 40-50% in NYHA Class IV

                  F.      STAGES OF HEART FAILURE

1.      Stage A: At high risk for HF but without structural heart disease           or symptoms of HF. Examples: HTN, CAD, DM, cardiotoxins,                       FHx of CM.

2.      Stage B: Structural heart disease    but without symptoms of HF. Examples: Previous MI, LV systolic dysfunction, asymptomatic           valvular disease.

3.      Stage C: Structural heart disease with prior or current symptoms           of HF. Examples: Known structural heart disease, SOB and fatigue, reduced exercise tolerance.

4.      Stage D: Refractory HF requiring specialized interventions. Examples: Marked symptoms at rest despite maximal medical therapy.

                 G.      AIMS OF TREATMENT

1.      Prevention: Prevention and/or controlling of diseases         leading to cardiac dysfunction and heart failure and prevention of progression to heart failure once      cardiac dysfunction is established.

2.      Morbidity: Maintenance or improvement in quality of life.

3.      Mortality: Increased duration of life.