Category: HEARTe

Raza’s results

Raza in waiting room

Raza has had his echocardiogram which demonstrated HF-REF. This is probably due to his hypertension but he may require further investigations to confirm aetiology. Today he is in the practice to discuss his results.

Raza's results

To do list

See the Additional information box for more information on BNP.

The practice nurse (PN) considers Raza’s diagnosis

Practice nurse with thought bubble

Raza's red flag symptoms

Once a diagnosis of heart failure has been made, the severity of symptoms and level of incapacity can be categorised according to the New York Heart Association (NYHA) classification. This classification recognises four classes in which symptoms increase in severity, increasingly limiting the ability of patients to undertake normal daily activities.

Task Force for the Diagnosis and Treatment of Chronic Heart Failure, European Society of Cardiology. Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J 2001;22:1527-60. See the Additional Information box for more information on the NHYA classification.

Raza

Raza portrait

Raza is a 48 yr old man who has been called to the surgery for his annual hypertensive clinic.

Raza comes to the cinic for a health check

Pathophysiology of HF

Heart Failure progression is often described as a vicious circle. This refers to the maladaptive process where the body tries to compensate for the changes caused by the heart failing. This leads to a series of other processes which leads to a circle of heart failure. All the interventions utilised within heart failure management aim to improve symptoms and slow down progression. This simplified model illustrates the processes that occur as a result of a failing heart.

Heart failure pathophysiology

There are various other additional influences on this decompensatory cycle. These include neurohormonal responses, cell necrosis and death.

Most common causes of HF

CHD is the most common cause of HF, but below are some other common causes and a brief description of how this occurs.

Damage to the heart muscle: Excessive workload of the heart
  • Myocardial infarction (MI): muscle damaged due to blocked coronary artery supplying blood to muscle
  • Coronary Heart Disease (CHD): Interruption of blood flow within the coronary arteries can cause cardiac muscle weakness
  • Dilated Cardiomyopathy (DCM): global (all over) enlargement of the ventricles cause thinning of the cardiac muscle and poor pumping ability
  • Hypertension: high blood pressure or hypertension means that the heart has to work harder to pump the blood around the body. If untreated this can lead to thickening of the cardiac muscle and thereafter poor pumping ability and thinning over time.
  • Aortic stenosis (AS): when the aortic valve becomes stiff and narrowed it cannot function properly. This leads to increased pressure within the heart leading to poor pumping ability.
  • Hypertrophic Cardiomyopathy (HOCM): where the cardiac muscle becomes enlarged and thickened. This creates a stiff structure which in turn creates problems with the blood flowing through the heart.
  • Severe anaemia: when the cardiac muscle is deprived of oxygen rich blood carried on haemoglobin, the cardiac muscle cannot pump effectively and can fail.
  • Arrhythmias: if the volume of blood pumped out of the heart is not consistent (in arrhythmias such as atrial fibrillation) then the cardiac muscle is unable to pump effectively