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General Pathology Circulation Disorders - I Heart Failure Manifestations & Causes Jaroslava Dušková Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague Manifestations of Circulatory Failure in the heart outside heart Manifestations of Circulatory Failure in the heart – acute failure – chronic insuficiency - dilation hypertrophy concentric, excentric outside heart Manifestations of Circulatory Failure outside heart Acute capilarovenous congestion acute venostasis cyanosis (5g% of red. hemoglobin!) cardial hydrops edema Chronic cyanotic induration (spleen, liver, kidney) red induration (lung) venostatic catarrh vessels hypertrophy cardial hydrops edema Cardiac Failure venous pressure capillary pressure cardiac output arterial volume ADH renin Na & H2O retention plasma volume transudation EDEMA Hypertrophic Heart mechanic and paracrine stimuli changed geometry concentric & excentric hypertrophy decreased capillary myocytes ratio myocytes & interstitial tissue composition changes – fetal proteins synthesis – beta myosin – early genes induction c-myc, c-fos, c-jun decreased beta- adrenergic receptors increased oxygen consumption HEART FAILURE Causes of Circulatory Failure (1) in the heart – endocardium (malformations, fibroelastosis) – myocardium (cardiomyopaties,inflammations, hypoxia, tumor, trauma) – pericardium (inflammations, synechiae, tumors, hemopericardium) – neurological reflex (syncopa) in pulmonary circulation in body circulation (cont.) Causes of Circulatory Failure (1) in the heart – endocardium – myocardium – pericardium – neurological reflex pressure changes – in pulmonary circulation – in body circulation hypertension hypotension – shock, collapse (syncope) Cardiomyopathy Def.: specific (non ischaemic, non inflammatory) heart muscle disease leading to heart failure hypertrophic (obstructive) dilated (congestive) restrictive (obliterative) Causes of Circulatory Failure (2) in pulmonary circulation – acute pulmonary hypertension (pneumonia, pleuritis, embolism) – chronic pulmonary hypertension (emphysema, fibrotising processses) COR PULMONALE acutum seu chronicum in body circulation (cont.) Causes of Circulatory Failure (3) in body circulation – hypertension „essencial“ renal endocrine COR HYPERTONICUM COR BILATERALE changed blood composition (cont.) Causes of Circulatory Failure (4) changed blood composition – anaemia – plethora – oligemia – hyperphydremia – anhydria (exsicosis) – hyperproteinemia – hypoproteinemia Shock Def.: hypoperfusion of cells and tissues due to decrease of effective circulating volume Shock - pathogenesis – decreased amount of blood – decreased cardiac output – redistribution of blood Shock - types & causes – cardiogenic – hypovolemic (hemorrhage, fluid loss – burns, vomiting) – septic (bacterial infections G- endotoxic, G+ septicemia) – neurogenic (anesthesia,spinal cord injury) Shock - stages – early (non progressive - reversible) – progressive – cell derangement – irreversible – cell death Shock - morphology – ischaemic encephalopathy – shock lung – shock kidney – adrenal hypolipoidosis – liver – centroacinar necroses – pancreas focal necroses Collapse Def.: temporary disproportion of the blood & vessels volume due to vasodilation (heat, psychogenic stimuli…) mostly self limited, can proceed to shock