Download Heart and circulatory failure

Heart and Circulatory
Failure
Lectures from Pathological
Physiology
Dental Medicine
Study materials from Pathological
Physiology, school year 2007/2008
© Oliver Rácz 2008
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The concept of heart failure
Old: Cardiac dropsy* due to decompensation of
ventricular hypertrophy.
Recent: Neuroendocrine, hormonal and inflammatory
factors, molecular mechanism of adaptation and
deadaptation – not only the contractile elements.
A syndrome which develops after different
diseases/conditions producing cardiac/circulatory injury.
Failure = the system is not able to meet proper
performance
For clinicians:
Earlier identification, intervention, better therapy
Dropsy = hydrops, stasis
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Young, Haas,
Starling:
American College
of Cardiology,
American Heart
Association
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General etiology of HF
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Clinical etiology of heart failure
Coronary artery disease
Hypertension
Valvular dysfunction
Congenital defects
Cardiomyopathies
Myocarditis, endocarditis, pericarditis
Arrhytmias
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Heart failure – basic terms
Forward and backward failure
NYHA classification I – IV
Forms:




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Left ventricle, right ventricle, both
Acute and chronic
Systolic and diastolic dysfunction
Decrease of CO, sometimes increase
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Pathogenesis of HF
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Cellular adaptation - maladaptation
Myocytes do not divide
Contractile proteins regenerate (30 – 90 d)
Stimuli: GH, ATII, Noradrenaline, TNF-a,
Interleukins, ADH, NO, ANP…
Growth of cells – hypertrophy, back to fetal
phenotype
Apoptosis and necrosis
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Neurohumoral (mal)adaptation
Fixed reaction to decrease of cardiac
output in shock
Adrenergic stimulation (afferentation
through baro- & chemoreceptors – CNS)
Renin – angiotensin – aldosteron system
(RAAS) – renal & local
Erytropoetin
Subclinical inflammation (TNF-α)
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