Heart Failure: Signs and Treatment Guidelines

Heart failure occurs when the heart is unable to supply output that is sufficient for the metabolic needs of the tissues, in the face of adequate venous return.

Causes of Heart Failure

Common causes of cardiac failure are

• Hypertension,
• Valvular heart disease,
• Ischaemic heart disease,
• Anaemia, and
• Pulmonary thromboembolism.

Clinical Features of Heart Failure

• Tachycardia,
• Gallop rhythm,
• Raised Jugular venous pressure,
• Dependent oedema,
• Tender hepatomegaly,
• Orthopnoea,
• Fatigue,
• Exercise intolerance, and
• Basal crepitations.

Precipitating factors

Poor compliance with drug therapy;

Increased metabolic demands, e.g., pregnancy, anaemia;

Progression of underlying disease, e.g., recurrent myocardial infarction,

Uncontrolled hypertension;

Cardiac arrhythmias;

Pulmonary embolism;

Infective endocarditis;

Infection, e.g., pneumonia.

Diagnostic Investigations of heart failure

Chest x-ray: May show cardiac enlargement as well as evidence of other cardiac or pulmonary lesions.

Full Hemogram – To rule out anaemia, infection

Urea and electrolytes to check for any electrolyte imbalance ie potassium

Electrocardiogram (ECG)

Echocardiogram

General management of Heart Failure

The general management of heart failure entails;

Restrict physical activities.

Order bed rest in cardiac position.

Give oxygen by mask for cyanosed patients.

Restrict salt intake, control fluid intake, and measure urine output.

Measurement weight daily.

Pharmacological management

Frusemide 40–160mg PO OD; use higher doses in patients who were already on it.

Digoxin 0.125–0.25mg PO OD, useful in atrial fibrillation. Loading dose for digoxin may be given to patients who are not on digoxin beginning with 0.25– 0.5mg PO QDS up to a total of 1.0–1.5mg and then put on maintenance.

Potassium supplements: Advise patient to eat fruits, e.g., bananas or oranges.

Prophylactic anticoagulation: Heparin 2,500 units SC BD in those patients who are on strict bed rest and marked cardiomegaly.

Treat underlying causative factor such as hypertension and anaemia.

If patients fail to respond to above measures consider angiotensin-converting enzyme inhibitors, e.g., captopril 6.25–12.5mg PO TDS. Enalapril 2.5–10mg PO OD/BD