Pathophysiology of Cardiac Failure Flashcards

1
Q

What is heart failure

A

Any Structural or Functional Cardiac Disorder that leads to Inability to Maintain Adequate Circulation

Heart Fails to Supply Enough Blood to Meet Metabolic Demand of the Tissues

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2
Q

How does HF develop

A

HF usually develops Gradually and Insidiously due to Cumulative Effects of Disorders of Various Etiology

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3
Q

What physiologic factor cause heart failure

A
  • decreased preload (dysfunction in diastole/filling)
  • increased afterload (systole)
  • decreased ventricular contractility (systole)
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4
Q

Causes of impaired preload

A
  • LV Hypertrophy
  • Myocardial Fibrosis
  • Restrictive Cardiomyopathies
  • Constrictive Pericarditis
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5
Q

Causes of increased afteload

A
  • Systemic Hypertension
  • Aortic Stenosis
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6
Q

Causes of impaired contractility

A
  • Coronary Atherosclerosis (IHD)
  • Mitral Regurgitation
  • Aortic Regurgitation
  • Dilated Cardiomyopathies
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7
Q

How is HF characterised

A

Onset (acute/chronic)
Side (left/right)
Conraction or relaxation dysfunction (sytolic/diastolic)
Low CO/High CO

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8
Q

When would we have high CO HF

A

when the supply is normal but because of high demand it is not enough

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9
Q

When would we have high CO HF

A

when the supply is normal but because of high demand it is not enough
- chronic anemia
- increased metabolic rate (eg. thyrotoxicosis)

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10
Q

Causes of LSHF

A

*Hypertension
*IHD
*Aortic Stenosis
*Mitral Incompetence

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11
Q

Causes of RSHF

A

*COPD - Mitral Senosis
*LSHF
* Pulmonary Stenosis
*Tricuspid valve disease

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12
Q

What are the physiologic compensatory mechanism to inadequate supply

A

Inc. HR
Dilation

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13
Q

What are the pathologic compensatory mechanism to inadequate supply

A

Inc. HR
Dilatation
Hypertrophy
Neuro-hormonal (RAAS)

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14
Q

What is the effect of dilatation

A

Inc ventriular size = Inc contraction
Physiologic: active dilatation (not forced)
Pathologic: passive dilatation (forced)
= incomplete emptying

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15
Q

Pathologic effect of Inc. Heart rate

A

No sufficient time for complete emptying

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16
Q

Consequence of hypertrophy

A

muscles become too big for blood supply & nutrients → Incomplete Emptying

17
Q

Consequence of incomplete emptying

A

further HF = further dilatation

18
Q

What is the neurohormonal response in HF

A
19
Q

Effects of HF

A
  1. Impaired Tissue Perfusion [Forward Effect]
  2. Venous Congestion
  3. Edema
20
Q

Effects of LSHF

A
  • Impaired Tissue Perfusion
  • Pulmonary Congestion & Edema
21
Q

Effects of RSHF

A
  • ↓ Output to lungs (insignificant unless due to LSHF)
  • Systemic Venous Congestion
  • Generalized Edema
22
Q

Causes of Chronic HF

A
  • Hypertension
  • IHD
  • COPD
  • Valve Disease (AoS – MS)
  • Severe anemia
23
Q

Effect of chronic HF

A

Fully developed compensatory mechanisms
Chronic venous congestion
Cardiac edema

24
Q

Causes of acute HF

A
  • Coronary occlusion
  • Pulmonary embolism
  • Cardiac tamponade
  • Malignant hypertension
  • Acute myocarditis
25
Q

Effect of acute HF

A

No time for compensatory mechanisms
Multi-organ failure
Acute pulmonary edema