Heart Failure

Question 1

How does Heart failure occur?

Answer 1

when the heart cannot generate sufficient output to meet the metabolic demands of the tissues

Question 2

What are the causes for heart failure?

Answer 2

 Systolic dysfunction
 Diastolic dysfunction
 Valve dysfunction (due to endocarditis)
 Abnormal load (fluid or pressure overload)
 High-output failure(hyperthyroidism or anemia)

Question 3

What happens in the CHF if there is a heart failure?

Answer 3

In CHF the heart can no longer efficiently pump the blood delivered to it by venous circulation leads to increase end-diastolic Vol. increased E.D. pressure and leads to increase venous pressure

Question 4

What is forward failure?

Answer 4

Inadequate cardiac output

Question 5

What is backward failure?

Answer 5

increased congestion of venous circulation

Question 6

What is Frank-starling mechanism?

Answer 6

increase in end-diastolic volume leads to stretching of cardiac muscle fibers
leads to more forcible contraction leads to increase in C.O.

Question 7

What happens in the Activation of neurohumoral system?

Answer 7

Release of norepinephrine leads to increase in H.R., myocardial contractility &
vascular resistance.

Activation of renin-angiotensin-aldosterone system.

Release of atrial natriuretic peptide

Question 8

What are the changes occurring in myocardial structural?

Answer 8

 Hypertrophy

 Pressure overload leads to Concentric hypertrophy

 Volume overload leads to Eccentric hypertrophy Degenerative changes

 Increased myocardial O2 demand leads to Ischemic injury.

Question 9

What are the causes seen in the left heart failure?

Answer 9

1. Ischemic heart disease
2. Systemic HTN
3. Mitral and aortic valve diseases
4. Primary diseases of the myocardium

Question 10

What are the gross features seen in the heart?

Answer 10

 Myocardial infarction or valvular deformities

 Left ventricleusually hypertrophied & may be dilated

 LVD leads to mitral insufficiency leads to LA enlargement leads to Atrial fibrillation leads to decrease stroke volume or blood stasis & thrombus formation

Question 11

What are the microscopic features seen in the heart?

Answer 11

• Myocyte hypertrophy with interstitial fibrosis.

- Lesions contributing to heart failure e.g., MI

Question 12

What are the gross features seen in the Lungs?

Answer 12

 Pulmonary congestion &
edema
 Pleural effusion
 Heavy & boggy lungs

Question 13

What are the microscopic features seen in the lungs?

Answer 13

 Perivascular & interstitial transudates
 alveolar septal edema
 Accumulation of edema fluid in alveolar spaces
 Heart failure cells – Hemosiderin -containing macrophages in alveoli.

Question 14

What are the clinical features seen in left-sided heart failure?

Answer 14

 Dyspnea on exertion
 Cough
 Orthopnea
 Paroxysmal nocturnal dyspnea
 Cardiomegaly
 Tachycardia
 Third heart sound (S3)
 Fine rales at the lung bases
 Progressive ventricular dilation leads to Mitral regurgitation & systolic murmurs.
 Prerenal azotemia
 Severe CHF leads to hypoxic encephalopathy

Question 15

What happens if the atria is dilated in left sided heart failure?

Answer 15

Atrial dilation leads to atrial fibrillation (irregularly irregular heart beat)

Question 16

What happens if CO is decreased in left sided heart failure?

Answer 16

 Decreased C.O. leads to decreased renal perfusion leads to stimulation of renin-angiotensin-aldosterone axis leads to increase intravascular V & P leads to pulmonary edema worsens

Question 17

What are the causes of right sided heart failure?

Answer 17

 Intrinsic disease of lung parenchyma & /or pulmonary vasculature leads to cor pulmonale.

Pulmonic or tricuspid valve disease.

Congenital heart diseases with left to right shunt leads to V & P overload.

Engorgement of systemic & portal venous system leads to morphologic & clinical features

Question 18

What are the morphological features seen in liver and portal system?

Answer 18

 Congestive hepatomegaly.

 Passive congestion leads to Nutmeg liver.

 Centrilobular necrosis along with sinusoidal congestion.

 Cardiac cirrhosis.
 Elevated pressure in portal vein leads to congestive splenomagly.

 Chronic passive congestion of bowel wall leads to edema.
 Ascites, pleural & pericardial effusions.

Question 19

On what portions the peripheral edema is seen?

Answer 19

1. Pedal
2. Pretibial
3. Presacral edema
    Anasarca

Question 20

What are the clinical features seen in right sided heart failure?

Answer 20

 In pure right sided heart failure leads to rare respiratory symptoms.
 Systemic and portal venous congestion with Hepatosplenomegaly.
 Peripheral edema, pleural effusion and ascites.