Heart Failure


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.


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.

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