Congestive Heart Failure.pdf

Congestive Heart Failure CHF end point of many cardiac diseases Progressive disease with poor prognosis CAUSES: 1. systolic dysfunction : Most cases ( IHD or hypertension) 2. diastolic dysfunction, LVH, constrictive pericarditis, elderly, DM 3. valve dysfunction 4. increased tissue demands: hyperthy...

Congestive Heart Failure CHF end point of many cardiac diseases Progressive disease with poor prognosis CAUSES: 1. systolic dysfunction : Most cases ( IHD or hypertension) 2. diastolic dysfunction, LVH, constrictive pericarditis, elderly, DM 3. valve dysfunction 4. increased tissue demands: hyperthyroidism, anemia 5. idiopathic Pathogenesis: failure heart can not efficiently pump the venous return: result in 1. increased end-diastolic ventricular volume, 2. leading to increased end-diastolic pressures 3. elevated venous pressures. Thus, forward failure is always accompanied by increased congestion of the venous circulation— that is, backward failure Left-Sided Heart Failure: common causes : 1. (IHD), 2. systemic hypertension, 3. mitral or aortic valve disease, 4. amyloidosis MORPHOLOGY: The ventricle is usually hypertrophied & dilated (except in mitral stenosis). Secondary enlargement of the left atrium resulting in: Atrial fibrillation Stasis Thrombosis & embolic problems Lungs. Rising pressure in the pulmonary circulation resulting in congestion,edema ,pleural effusion ,edema fluid in the alveoli hemosiderin-laden alveolar macrophages—heart failure cells— Clinical Features & complications: 1. Exertional Dyspnea 2. cough 3. Orthopnea 4. Paroxysmal nocturnal dyspnea 5. Cardiomegaly 6. tachycardia, 7. a third heart sound (S3), 8. Lung crepitation 9. mitral regurgitation 10. atrial fibrillation, & thrombi &emboli Complications: In the kidneys: The reduced perfusion activates the reninangiotensin-aldosterone system. Causing retention of salt & water & an increase in interstitial fluid & blood volume. The pulmonary oedema is made worse. The reduced kidney perfusion causes retention of nitrogenous products (pre-renal azotemia). Brain: Hypoxic encephalopathy. Loss of attention. Irritability & restlessness. Right-Sided Heart Failure: consequence of left-sided heart failure pulmonary hypertension, (cor pulmonale) tricuspid valve disease, congenital heart disease There is: (i) Hypertrophy (ii) Dilatation of the right ventricle & atrium (iii) Possible bulging of the septum in the left ventricle MORPHOLOGY: 1. congestive hepatomegaly 2. passive congestion ( nutmeg liver) congested centrilobular areas are surrounded by no congested areas 3. long-standing the central areas can become fibrotic(cardiac cirrhosis). 4. portal hypertension leading to congestive splenomegaly & ascites 5. Chronic passive congestion of the bowel wall interfere with absorption of nutrients and medications 6. Peripheral edema of dependent portions :ankle (pedal) and pretibial edema & presacral Clinical Features & complications: Hepatic and splenic enlargement, peripheral edema, pleural effusion, and ascites