Download Heart failure Ventricular insufficiency Left heart failure (LHF

Heart failure
Ventricular insufficiency
• Decreased cardiac output
• Insufficiency with high cardiac output
• Cardial causes
• Extracardial causes
Causes:
• Ischemic heart disease is the most common cause
– (decreased lumen diameter by 75% ⇒ critical stenosis)
– Angina pectoris
– MI
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Pathophysiology of heart failure
Damage of myocardium
Heart failure as a pump
Activation of
neurohormones
Sympathetic NS, ADH
RAAS ⇒ angiotensin
Cytokines
Left heart failure (LHF)
Re-modulation
Hypertrophy
Fibrosis
Apoptosis
Hypertension (right heart: cor pulmonale)
Endocarditis
Myocarditis
Cardiomyopathy
Congenital abnormality
Pericarditis
Compensatory mechanisms
To increase cardiac output:
• Frank – Starling mechanism
• Activation of sympathetic NS (↑HR, +ino,
+dromo, +bathmo effects)
• Increase blood volume RAAS, ADH
Morphologic changes:
• Hypertrophy (overwhelm ↑BP)
• Dilation (overwhelm ↑volume or acute ↑BP)
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Adaptive
Mechanisms
Myocardial ischemia
Intermittent pain, mainly on exesion
• Angina pectoris
Continuous pain, even at rest
• Myocardial infarction
Pathogenesis
of Ischemic
Heart
Disease
Myocardial
Infarction
LHF; Consequences
• Increased pressure in lulmonary veins
– Pulmonary edema
– Rupture of capillaries => expectoration
of pink, foamy sputum, i.e. asthma
cardiale
• Decreased cardiac output
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LHF; Low cardiac output
• Low BP ⇒ activation of baroreceptors in aortic
arch ⇒ leads to activation:
– SNS ⇒ ↑ HR, + ino, + bathmo, +dromo effects ⇒
possible rhythm disorders
– RAAS ⇒ angiotensin ⇒ vasoconstriction and
myocardial re-modulation
⇒ ALD ⇒ ↑ reabsorption of Na+ and H2O
⇒ Secondary hyperaldosteronism
– ADH ⇒ vasoconstriction and resorption of H2O
• Circulus vitiosus
Right heart failure (RHF)
Causes:
• Ischemia of right ventricle, inflammation…
• Pulmonary HTN
– Lung disease
• obstructive (COPD,….)
• Restrictive (fibrosis, ……)
– Left cardiac insufficiency
• Pulmonary embolism (often leads to acute
failure)
RHF; Consequences
• Increased central venous pressure
– ↑ filling of jugular veins
– Congestion of liver
– Edemas in lower extremities from venostasis
• Decreased right heart output, which can
lead to decreased left ventricular filling and
its insufficiency
Central cyanosis
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Biventricular failure
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LHF and as complication RHF
Inflammation
Cardiomyopathy
Extensive MI
Arrhythmias
Biventricular
failure
– Edemas are do not develop
• Newborns
Sources:
• http://www.heart.org/HEARTORG/Conditions/HeartFailur
e/AboutHeartFailure/Types-of-HeartFailure_UCM_306323_Article.jsp
• http://www.medicalhealthtests.com/articles/561/healtharticles/left-sided-heart-failure.html
• http://www.emedicinehealth.com/rightsided_heart_failure-health/article_em.htm
• http://www.youtube.com/playlist?list=PLUwT22wA6lPg_YyFOTTrJ6GJviSFnqfq
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