Congestive Heart Failure
By:
Dr Nazia Qamar
.
LEARNING OBJECTIVES
• Describe its etiology
• Describe its Pathogenesis
Contents
• Definition
• Types
• Etiology
• Epidemiology
• Risk Factors
• Pathophysiology
• Morphology
• Signs and symptoms
• Complication
Definition
HF is a complex 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.
Congestive Heart Failure describes a
condition where the heart muscle is weakened and
cannot pump as strongly as before.
Heart Failure
• This means less oxygen is reaching the organs and
muscles which can make feel tired and short of
breath.
• CONGESTIVE HEART FAILURE – refers to the state
in which abnormal circulatory congestion exists a
result of heart failure
• There are three types of heart failure and experts
differentiate them accordingly:
• Classification on the basis of location
✓ Right side heart failure
✓ Left side heart failure
✓ Biventricular heart failure
• Classification based on pumping ability
✓ Heart failure with reduced left ventricular function
✓ Heart failure with preserved left ventricular function
• Classification based on course of disease
✓ Acute heart failure
✓ Chronic heart failure
Etiology
• Heart failure is caused by systemic hypertension in 75% of cases.
• Structural heart changes, such as valvular dysfunction, cause
pressure or volume overload on the heart.
• Heart is unable to pump enough blood to meet tissues O2
requirements
• Congenital heart defects
• Severe lung disease
• Diabetes
• Severe anemia
• Overactive thyroid gland (hyperthyroidism)
• Abnormal heart rhythms
Etiology
• Increase in Pulmonary pressure results fluid in alveoli
(PULMONARY EDEMA)
• Increase in Systemic pressure results in fluid in tissues
(PERIPHERAL EDEMA)
Health conditions that either damage the heart or make it work
too hard
Coronary artery disease
Heart attack
Heart muscle diseases (cardiomyopathy)
Heart inflammation (myocarditis)
Risk Factors
• Hypotension
• Fluid retention & worsening CHF
• Bradycardia & heart block
• Contraindication in pts with CHF
exacerbation
Pathophysiology
• In order to maintain normal cardiac output, several
compensatory mechanisms play a role as under:
Compensatory enlargement in the form of cardiac
hypertrophy, cardiac dilatation, or both.
• Frank starling mechanism
• Myocardial adaptation
• Activation of neurohumoral system
Pathophysiology
• STARLING’S LAW
In which increased filling volumes dilate the heart and
thereby increase functional cross-bridge formation
within the sarcomeres, enhancing contractility
• This is achieved by increasing the length of
sarcomeres in dilated heart
• Increases the myocardial contractility and thereby
attempts to maintain stroke volume.
Myocardial adaptation
• Myocardial adaptations, including hypertrophy
with or without cardiac chamber dilation. The
collective molecular, cellular, and structural
changes that occur as a response to injury or
changes in loading conditions are called
ventricular remodeling. Often adaptive, especially
in early stages, these changes can culminate in
impaired cardiac function.
Pathophysiology
Ventricular remodeling
Altered cardiac
rhythm
Activation of neurohumoral systems,
• Tachycardia (i.e. increased heart rate) due to
activation of neurohumoral system e.g. release of
norepinephrine and atrial natriuretic peptide,
activation of renin-angiotensin aldosterone
mechanism..
CARDIAC HYPERTROPHY: PATHOPHYSIOLOGY AND
PROGRESSION TO FAILURE
CARDIAC HYPERTROPHY
MORPHOLOGY OF CARDIAC HYPERTROPHY
Pathophysiology
• Heart failure results in DEPRESSION of the
ventricular function curve
• COMPENSATION in the form of stretching of
myocardial fibers results
• Stretching leads to cardiac dilatation which
occurs when the left ventricle fails to eject its
normal end diastolic volume
Compensatory Mechanisms
• Sympathetic nervous system stimulation
• Renin-angiotensin system activation
• Myocardial hypertrophy
• Altered cardiac Rhythm
Pathophysiology
Pathophysiology
Renin-angiotensin system
Renin + Angiotensinogen
Angiotensin I
Angiotensin II
Aldosterone Secretion
Peripheral
Vasoconstriction
Salt & Water Retention
Plasma Volume
Afterload Edema
Preload
Cardiac Output
Cardiac Workload
Heart Failure
Signs and symptoms of CHF
• Shortness of breath often with activities or while lying flat
• Weakness and fatigue
• Awakening short of breath at night
• Need for increased pillows at night – helps lungs drain of
excess fluid
• Coughing or wheezing
• Swelling of feet and legs or other “dependent” areas
• Anorexia/loss of appetite
• Weight gain
Symptoms of HF
• Fatigue
• Activity decrease
• Cough (especially supine)
• Edema
• Shortness of breath
Complications
• Cardiac arrhythmia
• Hypotension
• Amrinone………. Thrombocytopenia, liver enzyme
• Milirinone…….. Bone marrow suppression, liver
toxicity
Complications
Heart
• SA and AV node suppression
• AV block
• Atrial arrhythmia
• Ventricular arrhythmia
Thank you……
