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Heart Failure

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14 views

Heart Failure

Uploaded by

Kritik Anny
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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HEART FAILURE

Shiesta Sharma
19093
Definition
Heart failure is defined as the
pathophysiologic state in which there is
impaired cardiac function that is unable to
maintain an adequate circulation for the
metabolic requirements of the tissues of
the body.

Chronic form of heart failure in which


there is evidence of congestion of
peripheral circulation and lungs, is known
as Congestive Heart Failure (CHF) and is
Etiology
Heart failure may be caused by one of the followings
factors that may act singly or in combination:

1. Intrinsic Pump Failure: There is weakening of the


diseased ventricular muscle due to which the heart
fails to act as an efficient pump. It is the most
common and most important cause of heart failure.
2. Increased workload on the heart: Increased mechanical
load on the heart results in increased myocardial demand
that leads to myocardial failure. This increased load on
the heart may be in the form of :-

a. Increased pressure load- Systemic and pulmonary arterial


hypertension, Valvular disease like mitral stenosis, aortic
stenosis and pulmonary stenosis, Chronic lung diseases.

b. Increased volume load- It occurs when a ventricle is


required to eject more than normal volume of the blood
resulting in cardiac failure.
3. Impaired filling of the cardiac chambers:
Decreased cardiac output and cardiac failure may
result from extracardiac causes or defect in filling of
the heart as in case of-

a. Cardiac tamponade, e.g. haemopericardium,


hydropericardium

b. Constrictive pericarditis
Types of Heart Failure
Depending upon whether the heart failure develops rapidly
or slowly, it may be acute or chronic.
Acute Heart Failure: Sudden and rapid development of
heart failure as occurs in the following conditions:
i) Larger myocardial infarction
ii) Valve rupture
iii) Cardiac tamponade
iv) Massive pulmonary embolism
v) Acute viral myocarditis
vi) Acute bacterial toxaemia.
Chronic heart failure: More often, heart failure develops
slowly as observed in the following states:
i) Myocardial ischaemia from atherosclerotic coronary
artery disease
ii) Multivalvular heart disease
iii) Systemic arterial hypertension
iv) Chronic lung diseases resulting in hypoxia and
pulmonary arterial hypertension
v) Progression of acute into chronic failure.
Backward heart failure:
 Either of the ventricles fails to eject blood normally
 Rise in end-diastolic volume in the ventricle
 Increase in volume and pressure in the atrium which is
transmitted backward producing elevated pressure in the
veins.

Forward heart failure:


 Clinical manifestations result directly from failure of the
heart to pump blood
 Diminished flow of blood to the tissues, especially
diminished renal perfusion and activation of renin-
angiotensin- aldosterone system.
Left Heart Failure: It is initiated by stress to the left
heart. The clinical manifestations of left-sided heart failure
result from decreased left ventricular output and hence
there is accumulation of fluid upstream in the lungs.

Right Heart Failure: Right-sided heart failure occurs


more often as a consequence of left-sided heart failure.
However, there are certain conditions that primarily affect
the right ventricle, producing right-sided heart failure.
Whatever be the underlying cause, the clinical
manifestations of right-sided heart failure are upstream of
the right heart such as systemic and portal venous
congestion, and reduced cardiac output.
Compensatory Mechanisms
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.
Tachycardia (i.e. increased heart rate) due to activation of
neurohumoral system.
Increase in the myocardial contractility in order to
maintain cardiac performance of the failing dilated heart.
This is achieved by increasing the length of the
sarcomeres in the dilated heart.
Compensatory mechanisms in heart failure
Risk factors for heart failure
Hypertension
Diabetes mellitus
Use of cardiotoxic substances (alcohol, tobacco, cocaine)
Hyperlipidemia
Coronary artery disease
Precipitating factors for heart failure in pre-
existing heart diseases
Physical and emotional stress
Excess salt intake
Systemic hypertension
IV fluid overload
Conditions associated with increased metabolic demand
Pulmonary embolism
Supervening heart diseases
Intercurrent illness
Signs and Symptoms of heart failure
Symptoms Signs
Left Heart failure
1. Dyspnea 1. Cardiac Sign
• Exertional dyspnea • Enlargement of LV
• Orthopnea • Gallop Rhythm S3
• Paroxysmal Nocturnal Dyspnea • Systolic murmur in
• Acute pulmonary edema apex
2. Cough 2. Pulmonary Sign
3. Fatigue • Crepitations
4. Decreased urine output • Pleural effusion
Symptoms Signs

Right Heart Failure

1. Leg Swelling 1. Raised JVP


2. Anorexia 2. Positive hepatojugular reflux
3. Oliguria 3. Hepatomegaly
4. Pain in right hypochondrium 4. Edema
5. Dyspnea 5. Pleural effusion and ascites

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