Heart failure

Question 1

Clinical presentation of left sided heart failure

Answer 1

Diastolic failure: women over the age of 65

• Pulmonary congestion, blood stasis, inadequate perfusion of the downstream tissues
• Increased risk for A fib and ultimately thrombi
• Dyspnea is the first sign. Starts with exertion eventually is orthopnea or paroxysmal nocturnal dyspnea
• Reduced ejection fraction leads to HTN through RAAS
• Azotemia and hypoxic encephalopathy can occur
• Systolic failure: decreased ejection fraction
• Diastolic failure: the heart is overly stiff and it cant get filled to the degree it needs
• Flash pulmonary edema may occur

Question 2

Pathogenesis of left sided heart failure

Answer 2

Causes: ischemic heart disease, HTN, aortic and mitral valvular diseases, primary myocardial diseases, DM and renal artery stenosis

Question 3

Morphology of left sided heart failure

Answer 3

• Specific cardiac signs vary depending on the disease process
• Generally hypertrophied and often dilated
• Myocyte hypertrophy and interstitial fibrosis
• Secondary dilation of the left atrium
• Wet and heavy lungs due to edema. Kerley B and C lines on chest X-ray. Edematous widening of alveolar septa. Accumulation of edema in the alveolar spaces
• Hemosiderin laden macrophages are signs of previous pulmonary edema

Question 4

Clinical signs of right-sided heart failure

Answer 4

• Engorgement of the systemic and portal veins
• Great fluid retention and peripheral edema with azotemia
• Venous congestion and hypoxia may impact mental function

Question 5

Pathogenesis of right-sided heart failure

Answer 5

-Increase in the pressure of the pulmonary circulation burdens the right side of the heart
-Individual right sided heart failure is called cor pulmonale: secondary to disorders like primary pulmonary HTN, recurrent pulmonary thromboembolism, sleep apnea, or altitude sickness
-Leftward bulging of the septum can effect the left ventricle.
-Kidney and brain predominantly effected
Mostly caused by left sided heart failure

Question 6

Morphology of right-sided heart failure

Answer 6

• Heart: varies due to the cause. Because most are caused by lung disease, most only exhibit right sided hypertrophy and dilation
• Liver: it develops into nutmeg liver. Congested red-brown pericentral zones. Severe centrilobular hypoxia causes centrilobular necrosis. Cardiac cirrhosis occurs when it becomes fibrotic. This also causes enlargement of the spleen (congestive splenomegaly). Bowel wall may be effect which interferes with nutrient absorption.
• Pleural and peritoneal: Develop ascites. Might cause dyspnea, impact lung inflation, and limit diaphragm excusion
• Subq: Pretibial and ankle edema. Bedridden patients may have presacral edema. Massive edema (anasarca) is possible