CONGESTIVE HEART FAILURE

Heart

Functions to pump oxygenated blood into the body

left ventricle

From the___, the heart will pump blood to be supplied to different parts of the body

Heart failure

Cardiac disorder that impairs the ability of the ventricle to deliver adequate quantities of blood to the metabolizing tissues during normal activity or at rest

Heart failure

The heart is still pumping but insufficient causing a decrease cardiac output

Stable heart failure

There is a symptom that would occur only if triggered by an activities →exert effort

Class 1

Class of heart failure:

Degree of effort necessary to elicit HF symptoms equals to those that would limit normal individuals

Class 1

Class of heart failure:

If the activity is more than the usual

Class 2

Class of heart failure:

Symptoms occurs with ordinary exertion ➔ Normal activity

Class 3

Class of heart failure:

Symptoms occurs with less-than-ordinary exertion ➔ Slight Activity

Class 4

Class of heart failure:

Symptoms occurs while at rest

Low output

This forms of heart failure is that the:

Metabolic demands are NORMAL but heart is unable to meet them

• Needs to supply blood into the brain, kidneys but the heart is unable to meet

High output

This forms of heart failure is that the:

Metabolic demands are INCREASED (hyperthyroidism, anemia) and the heart is unable to meet them

• Hyperthyroidism (lahat mabilis)→increase energy requirement

• If anemic, decreased RBC= increased blood supply requirement

Diastolic dysfunction

This forms of heart failure is that the:

Result of hypertrophy and stiffening of myocardium, reduced filling=reduced output

Diastolic dysfunction

This forms of heart failure is that the:

Reduced CO, normal ejection fraction and Does not respond to inotropic drugs

The heart fills 40 mL (low) but still ejects 40 mL (low)

• The normal is 60 mL

Example of a Diastolic dysfunction

Systolic dysfunction

This forms of heart failure is that the:

Reduced mechanical pumping action

Systolic dysfunction

This forms of heart failure is that the:

Reduced CO and reduced ejection fraction (<45%) and Results from MI

The heart fills 100 mL but only ejects 40 mL. The remaining will be accumulated in the heart resulting to heart failure

Example of Systolic dysfunction

Peripheral edema

Right side heart failure can cause

Pulmonary edema

Left side heart failure can cause?

When the heart pumps, the blood from the right ventricle (unoxygenated) will go to the lungs to accumulate oxygen. The oxygenated blood will return to the left ventricle. The left ventricle will now deliver the oxygenated blood to different parts of the body as the heart contracts.

• Right Sided Failure:

Failure of the right ventricle to pump blood to the lungs

Leads to the accumulation of fluid into the right ventricle

Congestion of peripheral tissues

Has a backup into the body since the excess fluid has not been pumped causing PERIPHERAL EDEMA

Mechanism of Right sided failure

causes ASCITES in which fluid collects in spaces within the abdomen

• Also causes GI congestion leading to ANOREXIA, GI DISTRESS, WEIGHT LOSS.

• OEDEMA (in ankle, feet, legs) - build-up of fluid in the body which causes the affected tissue to become swollen respectively.

Right side heart failure effect in the Gastrointestinal

Cause Hepatomegaly can lead to impaired liver

Right side heart failure effect in the Liver

Failure of left ventricle to pump oxygenated blood into the different parts of the body.

Since the contraction is weak, the blood will not reach the upper portion of the ventricle and the blood will leak into the lungs causing PULMONARY EDEMA

Mechanism of Left sided heart failure

Pulmonary congestion leads to ORTHOPNEA, COUGH WITH SPUTUM, PAROXYSMAL NOCTURNAL DYSPNEA

Effect of left sided heart failure in the lungs

Activity Intolerance

Signs of decreased tissue perfusion

Cyanosis and signs of hypoxia

Activities followed with a decreased cardiac output

Tachycardia

Decreased exercise tolerance

Shortness of breath

Cardiomegaly (enlargement of heart)

SIGNS AND SYMPTOMS OF ALL TYPES OF HEART FAILURE

Cardiomegaly

This symptoms of heart failure is due tot he accumulation of fluid in the heart

Heart Failure and decreased cardiac output trigger a complex scheme of compensatory mechanisms designed to normalize cardiac output

Pathophysiology of heart failure

Decreased renal blood flow (in the kidneys). This will trigger the kidneys to activate the sympathetic nervous system Increasing the amount of norepinephrine.

The B1 receptor activation in the juxtaglomerular apparatus will now lead to the release of renin→ Angiotensin I → Angiotensin II→ Aldosterone (RAAS) → Hormonal Stimulation

The presence of angiotensin will lead to vasoconstriction → increased afterload→ increased output (initial response since the heart will get tired (arouch) causing low output once again)

The presence of aldosterone will lead to increased amount of salt and water (retention)→ increased preload (venous return since volume) → increased filling and ejection of blood. The heart will get tired again leading back to low cardiac output

Example the viscious cycle of HF in a low cardiac output

Sympathetic Responses

Hormonal Stimulation

Concentric Cardiac Hypertrophy (cardiac remodeling)

Frank-Starling Mechanism

Compensation responds of the body when there is a low cardiac output

Concentric Cardiac Hypertrophy (cardiac remodeling)

What compensatory response is this:

Thickening of muscles (hypertrophy) → decreased size of ventricles → protection (initial purpose)

Concentric Cardiac Hypertrophy (cardiac remodeling)

What compensatory response is this:

Protects the heart from further damage and there are changes in the size and shape of the heart.

Concentric Cardiac Hypertrophy (cardiac remodeling)

What compensatory response is this:

Can still result in damage due to frequent changes in size and shape of the heart

Frank-Starling Mechanism

What compensatory response is this:

increased fiber dilation heightens the contractile force, which then increases the energy released

In the heart, the more stretched the purkinje fibers= more force to eject the blood during contraction. Too much stretching can lead to damage due to loosening of fibers.

Explain the Frank-starling mechanism

Afterload

Preload

Decompensation of the heart failure

Afterload

This decompensation tension in ventricular muscles during contraction.

Afterload

This decompensation is in the left ventricle, this tension is determined by the amount of force needed to overcome pressure in the pulmonary artery.

Preload

This decompensation is the force exerted on the ventricular muscle at the end of diastole that determines the degree of muscle fiber stretch.

ventricular end diastolic pressure

Preload decompensation is also known as?

Contractility

Preload decompensation is also a key in?