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Heart Failure – Systolic dysfunction and Diastolic dysfunction

Systolic Dysfunction

It is easy to recognize the Heart failure caused by systolic dysfunction and in simple words it can be mentioned as the inability of the heart to pump blood to the different parts of the body. This systolic dysfunction is characterized by a reduced ejection fraction that is less than 45%. The strength of ventricular contraction is reduced leading to inadequate cardiac output. This is caused by the dysfunction cardiac myocytes. Inflammation and infiltration can lead to the destruction of Myocytes and its components. The presence of Toxins and pharmacological agents also result in intracellular damage and oxidative stress. The ischemia results in infarction and scar formation. Once the myocardial infarction occurs, the dead myocytes got replaced by scar tissue, and affects the functioning of the myocardium. This can be manifested in ECG in form of abnormal or absent wall motion.

Diastolic dysfunction

The diastolic dysfunction  of the Heart failure is termed as the failure of the ventricle  to relax adequately and result in a stiff ventricular wall. This results in inadequate filling of the ventricle leading to inadequate stroke volume. This failure of ventricular relaxation causes elevated end-diastolic pressures, where the effects are similar to the systolic dysfunction including pulmonary oedema in left heart failure and peripheral oedema in right heart failure. Diastolic dysfunction is caused by those processes that results in systolic dysfunction and includes the causes that leads to changes in cardiac remodelling. Diastolic dysfunction manifest itself only in physiologic extremes the systolic function is maintained. The patient does not show any symptoms at rest and they become sensitive to increases in heart rate, and sudden bouts of tachycardia. The pharmacological agents like such as a calcium channel blocker or a beta-blocker, are used for adequate rate control that can slows down the AV conduction.

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Heart Failure – Myocardial Rupture

Myocardial rupture or heart rupture refers to the laceration or tearing of the ventricular and auricular walls of the heart, of the interventricular and interatrial septum, of chordae tendineae , of the papillary muscles or of the valves of the heart. It is price one of the serious consequences of an acute myocardial infarction. It is commonly observed three to five days after MI. The usage of early revascularization and intensive pharmacotherapy for treating MI, led to the decrease in the incidence of myocardial rupture to about 1%  of all MIs. This rupture usually takes place in the free walls of the ventricles, the papillary muscles, the septum between ventricles, or the atria. Rupture results due to increased pressure against the weak walls of the heart chambers because the heart muscle cannot pump the blood out effectively.

The risk factors for myocardial rupture includes occurrence of Myocardial infarction with no revascularization, advanced age, female sex, and absence of a previous history of MI. Moreover, the risk of rupture is higher in those individuals who are revascularized with a thrombolytic agent as compared to PCI. The shear stress that present between the infarcted segment and the surrounding normal myocardium makes it a susceptible for rupture.

Myocardial Rupture is a disastrous event that may lead to cardiac tamponade, where blood accumulates within the pericardium and compresses the heart so that it cannot pump effectively.  The rupture of the intraventricular  septum leads to a ventricular  septal defect from where the blood passes from the left side to the right side of the heart leading to right ventricular failure and pulmonary overcirculation. Moreover, the rupture of the papillary muscle causes acute mitral regurgitation and consequent pulmonary oedema or even cardiogenic shock. The symptoms of myocardial rupture include the recurrent chest pain, syncope, and tightness of jugular veins.

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Heart Failure – Epidemiology

Heart failure  is among the leading causes of hospitalization in persons older than 65. The occurrence of heart failure in the populations varies a lot and it depends on the gender, age, race and other factors. The mean age of patients that have heart failure is 75 years in developed countries. The population suffering from heart failure in developing countries is 2 to 3 percent of population.

Every year millions of people suffer from heart attack across the world and more than 50% of patients again gets hospitalised within 6 months after getting the treatment. The average duration of stay of patients in hospital is around 6 days. In the tropical countries, the major cause of Heart Failure is valvular heart disease or cardiomyopathy. As the underdeveloped countries develops and get richer, there is simultaneous increase in obesity, diabetes, and hypertension that causes heart failure.

The incidence of heart failure within USA is much higher in the races including Native Americans, African Americans, Hispanics, and immigrants from the eastern countries. This high prevalence of heart failure in these ethnic populations is associated with the high incidence of hypertension and diabetes.

Gender – the incidence of heart failure is same in both males and females. However, there are some substantial differences between the two genders in terms of response to heart failure. Females usually develop heart failure after the stage of menopause. In comparison to males, females are generally more depressed. Females show the similar symptoms as that of males but with more intensity. Also, females survive longer with heart failure as compared to men.

Race – As per the new information, there is difference in elements of heart failure occurrence in African Americans and Caucasians. This leads to difference in efficacy of various treatment therapies used for heart failure based on racial, genetic or ethnic backgrounds.

Age – Heart failure is considered to be a progressive medical disorder where the signs and symptoms of heart failure become more prominent with age.

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Congestive Heart Failure – Criteria

Congestive heart failure (CHF) refers to a condition where the heart is not able to pump enough blood to the various parts of the body. This failure of heart in its function of pumping blood can result from various causes including narrowing of the arteries that supply blood to the heart muscle,

Previous history of myocardial infarction where the scar tissue interferes with the functioning of heart muscle, high blood pressure, Dysfunctional heart valve and others . The criteria of the congestive heart failure can be classified into Major Criteria and Minor Criteria.

Major criteria – It includes the following processes that cause profound effects on the heart.

Acute pulmonary edema

Paroxysmal nocturnal dyspnea

Central venous pressure is over 16 cm H2O at the right atrium

Positive abdominojugular test

Crackles on lung auscultation

Cardiomegaly on chest radiography

S3 gallop (a third heart sound)

Weight loss of more than 4.5 kg in 5 days

Minor criteria- It includes the minor processes that suggests the possibility of heart failure.

Dyspnea on ordinary exertion

Pleural effusion

Hepatomegaly

Bilateral ankle edema

Tachycardia of over 120 beats per minute

Nocturnal cough

Decrease in vital capacity by 1/3 from the maximum

As per the Framingham criteria, the diagnosis of congestive heart failure needs to satisfy any one Levitra Super Active+ of the following two conditions.

(1) Simultaneous presence of at least two of the above major criteria

(2) Simultaneous presence of 1 major criterion in conjunction with any two of minor criteria

Minor criteria can only be accepted if they cannot be associated with any other medical condition like chronic lung disease, cirrhosis,pulmonary hypertension, nephrotic syndrome or ascites.

The Framingham Heart Study criteria are regarded as 100% sensitive and it is about 78% specific for detecting the definite congestive heart failure in the affected persons.

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