3: Congestive Heart Failure Flashcards
what is: the deficiency in ability of the heart to deliver blood to meet metabolic demands of peripheral tissues?
congestive heart failure;
(NOTE: The heart MAY deliver blood to meet metabolic needs at an elevated filling pressure)
why is congestive heart failure accompanied by organ congestion?
Accompanied by organ congestion due to failure of heart to keep
pace with venous return (“congestive heart failure”)
epidemiology of congestive heart failure (CHF)
- Common end-stage of many forms of chronic heart diseases
- Affect 5 million people annually, 1 million hospitalization and 0.3 million death
what are the classifications of congestive heart failure? (four key)
- Systolic dysfunction (pump failure)
- Diastolic dysfunction (> 65 yo, stiffness, more woman)
-
Affected side of heart
- Right-sided CHF
- Left-Sided CHF – *most common cause of ischemia
how does frank-starling mechanism adapt cardiac output?
increased stretch augments myocardial contractility
what are the neurohumoral responses in cardiac output adaptive mechanisms?
- Adrenergic activation: Increased heart rate & contractility, vasoconstriction
- Renin-Angiotensin-Aldosterone system
- Atrial Natriuretic Factor (ANF), Brain Natriuretic Peptide (BNP)
when does CHF result (with regards to cardiac output adaptive mechanisms)?
Congestive Heart Failure results when these mechanisms can no longer compensate for increased demand
how does the myocardium change in cardiac adaptive mechanisms?
Myocardial hypertrophy w/o chamber dilation:
– Physiologic (in athlete): ↑capillary density; ↓heart rate and pressure
– Pathologic (as in HT)
general pathology of CHF:
describe the FORWARD EFFECT
- Decreased arterial perfusion –> organ hypoxia
- Kidney (“pre-renal azotemia”)
- Brain
Pathology depends on the type of failure
general pathology of CHF:
describe the BACKWARD EFFECT
- Pooling of blood in venous system –> congestion, edema
- Liver
- Lung
Pathology depends on the type of failure
what are histological changes of left-sided Congestive Heart Failure?
(ACUTE changes)
- boxcar nuclei (these will enlarge in LV remodeling)
- – Acute changes
- Congestion: distension of alveolar capillaries
- Interstitial edema: transudation of fluid into perivascular interstitial spaces
- Alveolar edema: fluid enters alveolar spaces
- Alveolar hemorrhage: leakage of RBCs
what are histological changes of left-sided Congestive Heart Failure?
(chronic changes)
- boxcar nuclei (these will enlarge in LV remodeling)
- – Chronic changes
- Hemosiderin-laden macrophages in alveoli (“heart failure cells”)
- Interstitial fibrosis
- Pulmonary arterial hypertension vascular changes
Pathology of Left-Sided CHF:
gross pathology
Gross pathology:
- Heavy (>500g each)
- Exude pink, foamy fluid on sectioning
what is the MOST COMMON cause of Right-Sided congestive heart failure?
**Secondary to L-sided failure & isolated R-sided failure
((MOST common cause of Right sided HF is Left-sided Heart failure)
define: cor pulmonale
and causes
-
Right Ventricular enlargement in response to Pulmonary Arterial hypertension –> Edema
- Caused by either:
- intrinsic lung disease
- abnormal pulmonary vasculature
- Caused by either:
which diseases of pulmonary parenchyma predispose patients to Cor Pulmonale?
- chronic obstructibe pulmonary disease (COPD)
- cystic fibrosis
- diffuse PIF
- pneumoconioses
- bronchiectasis
which diseases of pulmonary vessels predispose patients to Cor Pulmonale?
- Recurrent pulmonary thromboembolism
- primary pulmonary hypertension
- extensive pulmonary arteritis
- vascular obstruction
- extensive pulmonary tumor microembolism
which disorders affecting chest movement predispose patients to Cor Pulmonale?
- Kyphoscoliosis,
- Marked obesity - marked obesity doesn’t affect chest movement in practice
- Neuromuscular diseases
which disorders inducing pulmonary arterial constriction predispose patients to Cor Pulmonale?
- Metabolic acidosis,
- hypoxemia,
- chronic altitude sickness - some people are attempting Mt Everest and not taking the time to acclimate to the decreased O2 tension
- obstruction of major airway
- idiopathic alveolar hypoventilation
how does pathology of ACUTE COR PULMONALE (CP) differ from CHRONIC COR PULMONALE?
- ACUTE CP: dilatation of RV, heart failure
- CHRONIC CP: RV wall thickening, may exceed 1 cm
what are the gross pathological changes of Right-sided CHF on the liver?
- Liver: “congestive hepatomegaly”
- Gross: “Nutmeg liver” (centrilobular congestion)
what are the MICROSCOPIC pathological changes of Right-sided CHF on the liver?
Depends upon severity and duration of CHF
- Congestion, distension of central veins and sinusoids (due to being filled w/ blood, “red infarct”)
- Centrilobular atrophy
- Centrilobular hemorrhage, hepatocyte necrosis
- Fibrosis (cardiac sclerosis) beginning in centrilobular zones; may rarely progress to cirrhosis (“cardiac cirrhosis”)
how does Right-sided Congestive Heart Failure affect the serosa-lined spaces? (pericardial, pleural, peritoneal)?
Fills w/ transudate fluid (ascites, pleural & pericardial effusions)
how does Right-sided Congestive Heart Failure affect the skin and subcutaneous tissue?
- skin is cold and sweaty
- legs, feet, and ankles start to swell as blood is backing up in veins (pitting edema)
Tx w/ dialysis if kidneys are failing; tx is diuretics to decrease the fluid
