Pathophysiology of CHF

CHFWhat is CHF?

Fix the underlying problem

Heart is a 2 sided pump

Both sides can fail independent of each other.

CHFWhat different types of pathophysiology cause it?Systolic Dysfunction

Diastolic Dysfunction

High Output States

CHFSystolic Dysfunction What is it? Is it only related to events that occur in Systole?-1. Decreased Contractility- a. Loss of Myocytes

- b. Over-stretched Heart

-2. Increased Afterload- a. Increased BP- b. Stenotic Valve- Pulmonic Valve and carcinoid syndrome 5HIAA

CHFDiastolic Dysfunction What is it? 1. Impaired Relaxation

2. Obstruction to filling

Can systolic and diastolic functions coexist?

CHFPressure volume loops are used to distinguish between systolic vs. diastolic dysfunction

CHFHigh Output States What is it?Pagets Disease

Anemia

Thiamine Deficiency

Hyperthyroidism

CHFThe failing heart and how it compensatesWhat does a failing heart mean, and what is decompensation? What does a failing heart look like?

Compensations made by a failing heartFrank Starling ForcesNeuro-Hormonal ChangesVentricular Remodeling

CHFWhat is looks like:

CHF CompensationsFrank StarlingLength Tension Mechanism

CHF CompensationsL sided failure and FrankBlood is not going to go forward

Blood is going to back up into L atrium and pulmonary venous circulationL Atrium, what happens when it distends?

CHF CompensationsHoarseness:

CHF CompensationsL sided Failure and FrankBlood eventually backs up into the pulmonary circulationWhat happens there?

Whats the deal with Frank Starling Forces?

CHF CompensationL sided failure and the lungs continuedPulmonary congestion

CHF CompensationL sided failure and lungs continuedPulmonary HypertensionDoes pulmonary hypertension happen immediately?

L sided CompensationL sided failure and CXRCephalization

Indistinct vessels, Kerly B-Lines

Whited Out lungs fields

CHF CompensationsL sided failure symptoms related to congestionBlood not going forward: Muscle fatigue ConfusionBlood going backwards:Atrial DistensionArrhythmiasThrombus formationHoarseness Mitral RegurgitationS3

CHF CompensationsL sided failure symptoms continued Blood going backwards continuedPulmonary congestionPulmonary edemaPulmonary hypertension R sided failureDyspnea, Dyspnea at nightNocturnal enuresisOrthopneaCardiac AsthmaHypoxia, cyanosis

CHF CompensationsR sided failure and Frank:Most Common Cause is?Cor pulmonale?Blood is going to eventually back up into the R atrium and systemic and portal venous circulation.

CHF CompensationsWhat happens when this blood backs up?Liver Congestion

Gastrointestinal Tract Nutmeg Liver

CHF CompensationsWhat happens when this blood backs up continuedPitting Edema Frank Starling Forces

Stasis Dermatitis

P02?

CHF CompensationsJVD jugular venous pressure chart

CHF CompensationsAcute R sided failureCauses?Would you expect to see any change to the R ventricle?

CHF CompensationsR sided failure symptoms from the backing up of blood:Pitting EdemaJVDGI discomfortLiver congestionRUQ painHepatojugular ReflexAscites Puddle sign

CHF complicationsWould you expect someone with R sided failure only, that is, no L sided failure, to have pulmonary hypertension or pulmonary edema?

CHF CompensationsNeurohormonal changes:Renin-Angiotensin System

Adrenergic System

ADH

CHF CompensationsRenin-Angiotensin System raise EABV, and lower plasma oncotic p.

CHF CompensationsDoes the Renin-Angiotensin System restore EABV back to normal?

Why is this harmful in the end?

CHF CompensationsAdrenergic System:Increased Sympathetic outflowIncreased effects of epinephrine on adrenergic receptors throughout your bodyWhat pathological process could keep the adrenergic system on even if the EABV is restored?

CHF CompensationsDoes the adrenergic system restore the EABV?

Why is this harmful in the end?

CHF CompensationsADH secretion

Why do its effects become blunted in long run?

CHF CompensationsVentricular Remodeling