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HEART FAILURE ن أجياد ثامر غفرا فرح عماد

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Page 1: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure

HEART FAILURE

غفران أجياد ثامر

فرح عماد

Page 2: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure

HEART FAILURE

A state that develops when the heart fails

to maintain an adequate cardiac output to

meet the demands of the body

characterized by:

1. Diminished cardiac output (forward

failure)

2. Damming back of blood in the venous

system (backward failure) or Both .

Page 3: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure

TYPES OF HEART FAILURE

*Left sided ,right sided & biventricular heart

failure

*Acute &chronic heart failure

*Compensated & decompensated heart

failure

* Forward & backward heart failure

* Systolic & diastolic dysfunction

Page 4: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure

Pathophysioylogy

Before reaching H.F we have many mechanisms that is compensatory mechanisms :Adaptive mechanismsby which the CVS maintains arterial pressure & perfusion of vital organs :

.1The Frank-Starling mechanism : >preload of dilation helps to sustain cardiac performance by enhancing contractility.

.2Myocardial structural change : Augmented muscle mass (hypertrophy) with or without cardiac chamber dilatation.

.3Activation of neurohumoral system :Release of norepinephrine – >heart rate—augments myocardial contractility.Activation of renin – angiotensin – aldosterone system.Release of atrial natriuretic peptide.

of H.F

Page 5: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure

Pathophysiology

Failure of adaptive mechanisms

Heart

failure

Page 6: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure

Pathophysiology

Systolic dysfunction:

Progressive detoriation of myocardial contractile function.

Occurs in cases of Ischemic injury, pressure or volume overload and DCM.

E.g. IHD and HTN.

Page 7: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure

Diastolic dysfunction:

Inability of the heart chamber to relax, expand, and fill sufficiently during diastole to accommodate an adequate ventricular blood volume.

E.g. Massive LVH, myocardial fibrosis, deposition of amyloid, or constrictive pericarditis.

Page 8: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure

PathophysiologyCardiac The onset of HF is preceded by

compensatory response of :hypertrophythe myocardium to > mechanical work.

The stimuli > the rate of protein synthesis, the amount of protein in each cell, size of myocytes, numbers of sacromeres & mitochondria : the mass & size of heart.

Also accompanied by selective up regulation of several immediate early response gene & embryonic forms of contractile& other proteins.

Page 9: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure
Page 10: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure

Schematic representation of the sequence of events in cardiac hypertrophy and its

progression to heart failure, emphasizing cellular and extracellular changes

Page 11: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure

LEFT SIDED HEART FAILURE

Progressive damming of the blood within the

pulmonary circulation and the consequence

of diminished peripheral BP and flow.

CAUSES :

* IHD

* SYSTEMIC HTN

* MI

* VALVULAR DISEASE

* Non_ischemic myocardial disease

Page 12: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure

MORPHOLOGY OF LEFT SIDED

HEART FAILUREHEART:

LEFT VENTRICLE is usually hypertrophied and often dilated

Secondary enlargement of the left atrium

LUNG:

Pressure in the pulmonary veins are transmitted retrograde to the capillaries and arteries

Pulmonary congestion & edema

Heavy wet lung

Page 13: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure

Kidney:

Decrease cardiac output

Reduction in renal perfusion

Activation of renal – angiotensin –aldosterone

System

Retention of salt & water with consequent expansion of the interstitial fluid and blood volumes

Pulmonary edema in lungs

Brain:

Hypoxic encephalopathy

Page 14: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure

Congestion & edema

Page 15: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure

Pulmonary congestion with dilated capillaries and leakage of blood into alveolar

spaces leads to an increase in hemosiderin-laden macrophages,

as seen here.

Page 16: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure

RIGHT SIDED HEART FAILURE

* Usually as a consequence of right sided

heart failure

* Cor pulmonale :chronic severe

pulmonary hypertension due to

increased resistance within the

pulmonary circulation.

* Other causes : multiple pulmonary emboli

& valvular disease

Page 17: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure

MORPHOLOGY OF RIGHT SIDED

HERTE FAILURE

HEART:

Hypertrophy and dilation are generally confined to right ventricle and atrium.

LIVER AND PORTAL SYSTEM:

* Passive congestive hepatomegaly(nutmeg liver)

* Centrilobular necrosis along with the sinusoidal congestion

* Congestive splenomegaly

* Ascites

Page 18: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure

Here is an example of a "nutmeg" liver seen with chronic passive congestion of the liver.

Note the dark red congested regions that represent accumulation

of RBC's in centrilobular regions. the natural nutmeg is at right.

Page 19: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure
Page 20: HEART FAILURE - University of Mosulmedicinemosul.uomosul.edu.iq/files/pages/page_2181505.pdf · *Left sided ,right sided & biventricular heart failure *Acute &chronic heart failure