c.

Pathophysiology (Schematic Diagram)

Predisposing Factors Precipitating Factors

Non-modifiable: • Previous MI
• Age: 65 years old • Hypertension
• Sex • Diabetes Mellitus
• Genetics
Modifiable:
• Lifestyle
• Obesity

Myocardial dysfunction

Decreased cardiac output

Low tissue perfusion to • activity Intolerance

• ECG: sinus tachycardia
the organs of the body
• Chest x-ray: enlarged heart

Decreased systemic BP
Activation of
baroreceptors

Decreased renal perfusion

Stimulation of
vasomotor regulating
centers in medulla

Activation of RAAS

Activation of sympathetic
nervous system
Renin activates formation of
angiotensin hormone

Increased catecholamines
Renin converts the plasma protein
angiotensin to angiotensin I

Angiotensin II stimulate
the release of
aldosterone from the Angiotensin-converting enzyme
adrenal cortex converts angiotensin I to angiotensin II
 Sodium and
water retention Angiotensin II is
arginine a potent
• rapid vasoconstrictor • increased afterload
vasopressin
weight • increased bp
endothelin
gain • increased heart rate
cytokines
• pale conjunctiva
Increase left
ventricular and
diastolic volume

Increase blood volume and • chest pain

pressure on the left atrium

Increase blood flow from

the pulmonary vessels

Left-sided heart failure

• bibasilar Blood backs up into left

crackles atrium and lungs
• paroxysmal
nocturnal
dyspnea
• cyanosis Pulmonary congestion • orthopnea
• cool or
vasocontricted
extremities
Pulmonary Edema • shortness of breath
• dyspnea
• productive cough
• fatigue • expectorating to
Increased pressure on right pinkish
• weakness
ventricle; dysfunctional • frothy sputum
ventricular filling • low oxygen
saturation=90%
• lack of • Pa02=53 mmHg
appetite/anorexia • sleep disturbances
• nausea Right-sided heart failure
• unexplained
• weight loss
• unexplained confusion
• dizziness Congestion of peripheral • pedal edema +3
• jugular vein distention pulses
• hepatomegaly
• ascites
• daytime oliguria with
recumbent nocturia
• nocturnal polyuria Congestive Heart Failure
• decreased alertness