Page 81 - Clinical Pearls in Cardiology

Jugular Venous Pulse 69

13. What is heart failure?
Heart failure can be systolic or diastolic. Systolic
heart failure can be defined as a clinical syndrome
characterized by an abnormality of cardiac structure or
function, leading to failure of the heart to deliver oxygen
at a rate commensurate with the requirements of the
metabolizing tissues, in the presence of normal filling
pressures. When the heart is able to deliver adequate
oxygen to the tissues only at the expense of increased
filling pressures, then the term diastolic heart failure is
used. Sometimes, both types of heart failure may co-exist
in some patients with varying degree of predominance
(Table 4).
Table 4: Systolic and diastolic heart failure
Systolic heart failure Diastolic heart failure
(dysfunction in ventricular (dysfunction in ventricular
contraction) relaxation)
Can occur at any age Usually in the elderly
Cardiomegaly usually present Cardiomegaly usually absent
S3 gallop may be present S4 gallop may be present
Common in coronary artery Common in hypertension
disease
Chest X ray: Cardiomegaly Chest X ray: Normal sized heart
ECG: Evidence of ischemia ECG: Left ventricular
Echo: Decreased ejection hypertrophy
fraction Echo: Normal ejection fraction
14. What do you know about the New York Heart
Association (NYHA) functional classification of heart
failure?
The NYHA functional classification is used to categorize
patients with heart failure in order to plan treatment. It