Heart failure

Heart Failure: Comprehensive Study Notes

General Information

  • Head of Propaedeutic of Internal Diseases Department №1: Prof. Mishlanov V.Ju., Correspondent-member of the Russian Academy of Science, PhD MD.

Definition of Heart Failure

  • Heart Failure Definition: The heart's inability to provide adequate cardiac output, or a disruption in its function to pump blood between the circulatory circles.

Classification of Heart Failure

  • Types of Heart Failure:
    • Acute Heart Failure (AHF):
    • Left Ventricular Acute Heart Failure (AHFLV)
    • Right Ventricular Acute Heart Failure (AHFRV)
    • Total Acute Heart Failure
    • Chronic Heart Failure (CHF):
    • Diastolic Heart Failure
    • Systolic Heart Failure
    • Combined Heart Failure

Acute Heart Failure

  • Definition: Clinical syndrome characterized by rapidly developing heart inability to provide adequate circulation according to the metabolic needs of the organism in a few minutes or hours.
  • AHFLV: Systolic or diastolic dysfunction of the left ventricle (LV) leading to congestion in the small circle of blood circulation, resulting in:
    • Cardiac dyspnea
    • Possible pulmonary edema
    • Severe cases may present with cardiogenic shock (hypotension, oliguria, etc.).
  • AHFRV: Heart failure due to acute right ventricular dysfunction, presenting with:
    • Acute congestion in the large circle of blood circulation.

Causes of AHFLV

  • Key Causes:
    • Decompensation of chronic heart failure
    • Acute ischemic heart disease (e.g., acute myocardial infarction (AMI), non-ST elevation myocardial infarction (NSTEMI) with persistent myocardial ischemia)
    • Hypertensive crisis
    • Acute onset of arrhythmia
    • Severe valve dysfunction
    • Severe acute myocarditis
    • Cardiac tamponade
    • Aortic dissection
    • Extra-cardiac factors such as volume overload, severe insult, extensive surgery, renal failure, drug overdose, and alcohol abuse
    • High Cardiac Output Syndromes: Septicemia, thyrotoxic crisis, anemia, blood shunt.

Mechanisms of AHFLV (According to W. Bleifeld, W. Kupper, 1987)

  • Mechanisms Include:
    • Acute disruption in transport function
    • Reduction in heart beat force
    • Impairment of relaxation
    • Mechanical causes
    • Cardiac rhythm disruption
    • Acute obstruction to filling of heart cavities
    • External causes
    • Blood inflow obstruction
    • Possible occurrence after cardiac surgery or trauma.

Causes of AHFRV

  • Key Causes:
    • Pulmonary thromboembolism
    • Large myocardial infarction of the right ventricle
    • Cardiac tamponade
    • Acute dysfunction of the tricuspid valve
    • Valve pneumothorax
    • Status asthmaticus
    • Severe pneumonia.

Pathogenesis of Acute Heart Failure

  • Pathophysiological Mechanisms Include:
    • Weakening of contractile activity of the LV (with satisfactory right heart function)
    • Disturbance of left ventricular myocardial relaxation
    • Increased pulmonary venous pressure
    • Increased capillary permeability
    • Swelling of the alveolar walls
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