Cardiovascular Critical Care I
dysfunction that impairs filling and/or emptying of the heart
Mortality rate of 50% within 5 years of diagnosis
Prognosis and treatment of HF largely depend on its etiology and staging.
Type
Heart Failure with Preserved EF
(HFpEF)
Heart Failure with Reduced EF
(HFrEF)
Dysfunction
| • | Diastolic – blood filling the heart |
|---|---|
| • | Systolic – blood emptying from the heart |
| • | May also coexist with impaired diastolic filling |
Characteristics
| • | LVEF ≥ 50% |
|---|---|
| • | Impaired relaxation and filling of the |
ventricle before contraction
| • | Commonly described as a “stiffened” |
|---|
ventricle
| • | Contractility remains “normal” |
|---|---|
| • | LVEF ≤ 40% |
| • | Impaired contraction and emptying of the |
ventricular cavity
| • | Commonly described as a “dilated” ventricle |
|---|
Clinical-
management
pearls
| • | Preload (volume optimization) is |
|---|
essential
| • | As diastolic dysfunction worsens |
|---|
– ventricular preload and diastolic
filling time must be maintained
| • | Conditions acutely decreasing preload |
|---|
may lead to decompensation (e.g.,
tachyarrhythmias)
| • | Preload optimization essential – at high risk of |
|---|
volume overload
| • | As systolic dysfunction worsens, cardiac output |
|---|
becomes increasingly afterload sensitive
| • | Conditions acutely decreasing or increasing |
|---|
preload or increasing afterload may lead to
decompensation
| • | Volume overload and increasing myocardial |
|---|
dilation may contribute to decreased valvular
coaptation and regurgitant flow
Common
medications
to avoid
| • | NSAIDs, with the exception of aspirin |
|---|---|
| • | Sympathomimetics |
| • | NSAIDs, with the exception of aspirin |
| • | Sympathomimetics |
| • | Most antiarrhythmics except for amiodarone |
and dofetilide
| • | Non-dihydropyridine calcium channel blockers |
|---|
EF = ejection fraction; LVEF = left ventricular ejection fraction.
Ischemic cardiomyopathy
Accounts for about two-thirds of HF cases
Caused by myocardial damage/death owing to CAD
Accounts for about one-third of HF cases
May be attributed to other causes (Box 4)