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CARDIAC FAILURE Dr. Mehzabin Ahmed

Heart failure Cardiac failure develops when the heart cannot maintain the circulation The pumping action of the heart fails to keep up to the requirements of the body

Types Acute: Abrupt failure of the chamber to empty resulting in dilatation of the chamber. Too quick- thus any compensatory mechanism cannot operate Patient is in circulatory collapse with low blood pressure‘Cardiogenic Shock’ Chronic: Longer course with a gradual increase in the severity of the underlying heart disease Compensatory responses like 

hypertrophy of the cardiac muscle,

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constriction of the arterioles,

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activation of the sympathetic and the renin angiotensin system

Chronic failure - hypertrophy dilatation of of the walls

Acute failurethe chambers

Hypertrophied heartthick walls and narrowed cavity

Causes of heart failure Right heart failure

Left heart failure Ischemic heart disease

Acute Cor Pulmonale Pulmonary embolism

Hypertension

Chronic Cor Pulmonale-

Valvular heart disease-

Chronic lung disease (obstructive or restricitive lung diseases)

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Aortic valve diseases

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mitral valve diseases

Myocardial diseases

Pulmonary Vascular Disease Chronic left heart failure Valvular Disease 

Pulmonic or Tricuspid

Left heart failure Left heart fails to pump effectively  Chambers fail to empty completely at systole and thus dilate  Rise in the pressure in left ventricle results in the increased pressure in the atrium and the vessels that drain into the left atrium (pulmonary veins and therefore the pulmonary capillaries)  This increase in the capillary pressure (hydrostatic) results in fluid collection in the alveoli- ‘Pulmonary Edema’  It also leads to poor systemic perfusion, as insufficient blood is pumped into the aorta and the arterial system.

Consequences of LHF

In pulmonary edema the alveoli are filled with pink edema fluid Normal lung

Pulmonary edema- dyspnoea, cough with production of pink frothy sputum. Poor output- hypotension, poor tissue perfusion and oxygenation- kidneys may be affected resulting in renal failure and brain may suffer from hypoxia Repeated episodes of left heart failure or chronic cases results in brown induration of the lung- long standing congestion of the pulmonary vasculature results in accumulation of abundant numbers of hemosiderin (brown pigment) laden macrophages

Chronic venous congestion of the lung fibrosis of the alveolar septae- firm, indurated

hemosiderin laden macrophages-

Right heart failure As the right heart fails the right ventricle dilates and increases the intra ventricular and then the intra atrial pressure.  Thus the systemic veins (vena cavae) that empty blood into the right atrium are congested resulting in the increase in the systemic venous pressure.  Also leads to poor perfusion of the lungs

Consequences of the RHF Raised pressure in the superior vena cava  raised jugular venous pressure Raised pressure in the inferior vena cava

Edema is seen in the lower limbs and dependent parts of the body

 chronic venous congestion in the portal circulation – hepatosplenomegaly and an enlarged congested liver- Nutmeg liver  congestion of the systemic circulation results in - edema of the lower limbs, - effusions like pleural effusions, ascites Azotemia Cerebral hypoxia (Encephalopathy

Nutmeg liver- alternate dark (areas of necrosis and congestion) and light ( areas of fatty change) regions

Congestive cardiac failure Failure of both left and right side of the heart. Usually starts as left heart failure (longstanding & severe)  Pulmonary congestion and increase in the pressure in the pulmonary.capillaries  Increased back pressure in the pulmonary arterial system causing increase in the resistance of the pulmonary arterioles  Right heart failure is caused due to the right heart having to pump against this increased resistance

Cardiac failure- when the heart fails to pump blood adequately Types

Causes

Consequences

Left sided heart failure

Diseases of the heart & blood vessels

Pulmonary Edema & Brown induration of the lung

Right sided heart failure

Lung diseases & Left heart failure

Systemic congestionSubcutaneous edema & pleural effusion Portal congestionNutmeg liver and ascites

At the end of the lesson on Cardiac failure, the student should be able to: Define cardiac failure. Enumerate the conditions that can lead to congestive cardiac failure. Enumerate the etiological conditions of pure left heart failure, pure right heart failure. Enumerate the extracardiac manifestations of left heart & right heart failure. Explain the pathogenesis of extracardiac manifestations of left heart & right heart failure.