ChesterCountyMedicineSpring2019 - 25

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development of Cardiorenal Syndrome results in further difficulty
in management, where treatment of CHF results in worsening
kidney function, and trying to reduce diuresis results in worsening
CHF and a close balance needs to be established.
Types of Heart Failure: The most common is left sided heart
failure, where the left ventricle cannot pump blood effectively to
the body.

FIGURE 5
* Edema of legs, ankles,
abdomen and even hands which
increase as day progresses
* Persistent unexplained cough
* Constant Fatigue and tiredness
with malaise
* Nausea and loss of appetite
and despite that weight gain
* Feeling of dizziness and
lightheadedness as cardiac
output drops

FIGURE 3
There are two kinds of left sided heart failure:
1. Systolic Heart Failure: When the function of the left
ventricle is diminished and cannot pump adequate blood for
the body's needs.
2. Diastolic Heart Failure: When the heart muscle stiffens, is
non-compliant and is unable to relax properly during diastole,
resulting in diminished forward flow.
Right sided heart failure occurs when the right ventricle
fails to pump adequate blood forward into the lungs and leads
to venous congestion. This can be caused by lung disease but
is often due to LV failure. When both chambers fail it is called
biventricular failure.

FIGURE 6
Functional Classification of Heart Failure:
The New York Heart Association classification is the most
widely used:
* Class I: No limitation of ordinary activity
* Class II: No symptoms at rest, slight limitation of physical
activity
* Class III: Marked limitation of physical activity, usually
comfortable at rest.
* Class IV: Inability to carry on any physical activity and
uncomfortable even at rest
Importance of this classification is to mark baseline and then
to show improvement with treatment.
Part 2 of this article will be featured in our Summer edition.

FIGURE 4
Symptoms:
* Shortness of breath is the most crippling symptom, first with
exertion and then at rest and lying flat becomes difficult because
of development of Orthopnea

This article was
a collaboration
between Mian A.
Jan, an interventional
cardiologist practicing
in Chester County, and
Zarshawn Jan, is in
his final year of medical school at Drexel University
College of Medicine.

SPRING 2019 | CHESTER COUNT Y Medicine 25
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ChesterCountyMedicineSpring2019

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