Heart Failure: Dyspnea and fatigue are main symptoms.

-Heart Failure with reduced Ejection Fraction: Ejection Fraction is < 40 percent.

-Heart Failure with preserved Ejection Fraction, EF >50 percent

-Causes: Hypertension, Amyloidosis, Sarcoidosis, Hemochromatosis, Pericarditis, Valvular disease, atrial myxoma.

-50 of patients with symptoms of heart failure has preserved Ejection Fraction.

-NYHA Functional Classification: 

Class 1: No limitation of physical activity.

Class 2: Slight limitation of physical activity.

Class 3: Marked limitation of physical activity.

Class 4: Unable to carry on any physical activity without symptoms of HF. Symptoms of HF at rest.

-BNP: Brain Natriuretic Peptide is secreted from the ventricles in response to ventricular volume expansion and pressure overload. BNP less than 100 excludes HF as cause of shortness of breath.

-Treatment: 

Preload Reduction: Diuretics, Nitrates

Afterload Reduction: ACE inhibitors, ARBs, Hydralazine, Nitrates.

Sympathetic blockade: Beta blockers

Aldosterone-antagonist therapy: Spironolactone, Eplerenone.

-Renin-Angiotensin System Inhibition by ACE inhibitors and ARBs. Both reduce mortality and morbidity.

-Beta Blockers: Should be started when the patient is stable and euvolemic. There is no absolute threshold ejection fraction where beta-blockers may not be used.

-Spironolactone: reduces mortality, improves ejection fraction.

-Entresto: Valsartan plus Sacubitril can reduce morality.

If you need more information on heart failure, please make an appointment with our physician, Paul Kattupalli MD.