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INTRODUCTION
Heart (or cardiac) failure: pathophysiological state in which the heart is unable to pump blood at a rate commensurate with the requirements of the metabolizing tissues or can do so only from an elevated filling pressure
Congestive heart failure (CHF): complex clinical syndrome characterized by abnormalities of left ventricular function and neurohormonal regulation, which are accompanied by effort intolerance, fluid retention, and reduced longevity
Etiology
It is a common end point for many diseases of cardiovascular system It can be caused by : -Inappropriate work load (volume or pressure overload) -Restricted filling -Myocyte loss
Pressure overload:
Loss of muscles:
Restricted Filling:
According to AHA, CHF is a clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood
In chronic heart failure, compensatory mechanisms like tachycardia, cardiac dilatation and cardiac hypertrophy try to make adjustments so as to maintain adequate cardiac output
Clinical manifestations of heart failure result from the accumulation of excess fluid to the left or right cardiac chamber, whichever is initially affected
C
Dyspnea, Fatigue Reduced exercise tolerance
D
Marked symptoms at rest despite max. therapy
Major pathological changes are: i) pulmonary congestion and oedema, causing dyspnoea and
orthopenia ii) decreased left ventricular output causing hypoperfusion and diminished oxygenation of tissues
Tissue anoxia
renal perfusion
COMPENSATORY MECHANISMS
Activation of NA, ANP Activation of RAAS mechanism Tachycardia Na+ Further stress on myocardium and water retention Cell stretching
Myocardial contractility
cardiac workload
Pathophysiology
Hemodynamic changes Neurohormonal changes Cellular changes
Hemodynamic changes
Neurohormonal changes
N/H changes
Sympathetic activity
Favorable effect
HR , contractility, vasoconst. V return, filling Salt & water retention VR
Unfavorable effect
Arteriolar constriction After load workload O2 consumption Vasoconstriction after load
Renin-Angiotensin Aldosterone
Vasopressin
interleukins &TNF- Endothelin
Same effect
Same effect
Cellular changes
Changes in Ca+2 handling
Changes in contractile proteins Program cell death (Apoptosis) Increase amount of fibrous tissue
Symptoms
Orthopnea, paroxysmal nocturnal dyspnea Low cardiac output symptoms Abdominal symptoms: Anorexia,nausea, Abdominal fullness, Rt hypochondrial pain
Congestive heart failure is a syndrome that can be caused by multiple underlying diseases such as:
Congenital heart disease Atherosclerosis Rheumatic fever Cardiomyopathy Valve disorders Ventricular failure Left or right-sided failure Hypertension Prolonged alcohol or drug addiction Previous heart attack Diabetes Chronic rapid heartbeats