HF Classification: Evolution and Disease Progression Four Stages of HF(ACC/AHA Guidelines) S Stage A: Patient at high risk for developing HF with no structural disorder of the heart Stage B: Patient with structural disorder without symptoms of HF Stage C: Patient with past or current symptoms of HF associated with underlying structural heart disease Stage D: Patient with end-stage disease who requires specialized treatment strategies Hunt, SA, et al ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult. 2001
HF Classification: Evolution and Disease Progression • Four Stages of HF (ACC/AHA Guidelines): Stage A: Patient at high risk for developing HF with no structural disorder of the heart Stage B: Patient with structural disorder without symptoms of HF Stage C: Patient with past or current symptoms of HF associated with underlying structural heart disease Stage D: Patient with end-stage disease who requires specialized treatment strategies Hunt, SA, et al ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult, 2001
Severity of Heart Failure Modes of death NYHA CHF NYHA‖ 12% 口cHF TOther 6% 口 Othel 口 Sudden 59% Death 口 Sudden 64% n=103 15% Death n=103 NYHAⅣ 口cHF 33% 口 Other 56% Sudden Death 11% n=27 MERIT-HF Study Group. Effect of Metoprolol CRXL in chronic heart failure: Metoprolol CR/XL randomized intervention trial in congestive heart failure(MERIT-HF). LANCET. 1999, 353: 2001-07
MERIT-HF Study Group. Effect of Metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL randomized intervention trial in congestive heart failure (MERIT-HF). LANCET. 1999;353:2001-07. Severity of Heart Failure Modes of Death 12% 24% 64% CHF Other Sudden Death n = 103 NYHA II 26% 15% 59% CHF Other Sudden Death n = 103 NYHA III 56% 11% 33% CHF Other Sudden Death n = 27 NYHA IV
Etiology of Heart Failure What causes heart failure? The loss of a critical quantity of functioning S myocardial cells after injury to the heart due to Ischemic heart disease -Hypertension 13 Idiopathic Cardiomyopathy Infections (e.g, viral myocarditis, Chagas disease) Toxins(e.g, alcohol or cytotoxic drugs) Valvular disease Prolonged arrhythmias
Etiology of Heart Failure What causes heart failure? • The loss of a critical quantity of functioning myocardial cells after injury to the heart due to: – Ischemic Heart Disease – Hypertension – Idiopathic Cardiomyopathy – Infections (e.g., viral myocarditis, Chagas’ disease) – Toxins (e.g., alcohol or cytotoxic drugs) – Valvular Disease – Prolonged Arrhythmias
The Donkey analogy Ventricular dysfunction limits a patient's ability to perform the routine activities of daily living NANMW
The Donkey Analogy Ventricular dysfunction limits a patient's ability to perform the routine activities of daily living…
Left Ventricular Dysfunction Systolic: Impaired contractility/ejection Approximately two-thirds of heart failure patients have systolic dysfunction Diastolic: Impaired filling/relaxation 30% (EF>40% EF<40% 70% O Diastolic Dysfunction 口 Systolic Dysfunction 1 Lilly, L. Pathophysiology of Heart Disease. Second Edition p 200
30% 70% Diastolic Dysfunction Systolic Dysfunction (EF < 40%) (EF > 40 %) Left Ventricular Dysfunction • Systolic: Impaired contractility/ejection – Approximately two-thirds of heart failure patients have systolic dysfunction1 • Diastolic: Impaired filling/relaxation 1 Lilly, L. Pathophysiology of Heart Disease. Second Edition p 200