Cardiovascular system

Applied Physiology
Presented by
Dr Mohamed Elnajid Mustafa
MBBS, MSc, MHPE
Objectives
• Heart failure.
• Introduction
• Left heart failure
• Right heart failure
• Congestive heart failure
• Compensatory mechanisms
• Shock.
• Hypovolemic shock
• Cadiogenic shock
• Distributive shock
• Obstructive shock
 Heart Failure
• A failure of the heart to pump
adequate amount of blood to
maintain the various functions
of the body.

• Classification:
• 1- Left heart failure
• 2-Right heart failure
• 3-Congestive heart failure.
 Heart Failure
• Clinically heart failure divided into:
• 1- Acute heart failure.
• 2- Chronic heart failure.

• Causes can be grouped into three categories:

• Myocardial failure, e.g. Myocardial infarction (MI).
• Mechanical abnormalities, e.g. valvular diseases,
congenital anomalies, HTN & Aortic stenosis.
• Cardiac arrhythmias; atrial fibrillation
 Left heart failure
• The left ventricle fails without
involvement of the right ventricle
 severe pulmonary congestion
(pulmonary edema).
• Causes: MI, mitral or aortic valve
disease or severe HTN.
• Symptoms :
• are predominantly fatigue,
exertional dyspnoea,
orthopnoea and PND, coughing
of frothy sputum (often blood
stained).
• Physical signs:
• Cardiomegaly, gallop Rythim,
functional mitral regurgitation
and crackles at the lung bases.
 Right heart failure
• The right ventricle fails without
involvement of the left ventricle 
Systemic venous Congestion.
• Causes: pulmonary HTN or mitral
stenosis.
• Symptoms :breathlessness due to
low pulmonary perfusion,
anorexia and nausea).

• Physical finding:
• jugular venous distension
• tender smooth hepatic
enlargement (hepatomegaly).
• pitting edema.
• development of free abdominal
fluid (ascites).
 Congestive heart failure
• Heart failure resulting in the accumulation of fluid in the
lungs and other body tissues.

• Due to  COP pulmonary congestion (backward

pressure)  dyspnea & orthopnea
 Compensatory mechanisms
• In acute state:
• (due to decreased COP & systemic venous congestion)
• Activation of cardio vascular reflexes (mainly baroreceptors
& chemoreceptors)  HR &  strength of myocardial
contraction (due to sympathetic activation).

• In chronic state:
• There is activation of the renal mechanisms that result in fluid
retention:
• Secretion of renin & activation of rennin-angiotensin system
• Secretion of aldosterone.

• The effects: Na & water retention  blood volume & venous

return  Rt atrial pressure and COP.
 Compensatory mechanisms
• When the COP can’t maintain adequate renal function,
more fluid is return:
• Rt atrial pressure, venous congestion  lower limb &
lower back edema.
• Liver enlargement
• Congestion of abdominal viscera and ascites.

• Decompensated HF:
• Further retention of fluid leads to stretch of myocardium
& edema of cardiac muscles .
Shock
 Shock
• Failure to maintain adequate blood flow to
the vital organs.
• Mainly its due to insufficient COP.
• Shock is divided according to the cause
into:
• Hypovolemic shock
• Cadiogenic shock
• Distributive shock
• Obstructive shock
 Hypovolemic Shock
• Loss of blood or body fluids will
decrease the venous return
resulting in inadequate SV so
reduced COP.
Subdivided according to the
cause into:
• Hemorrhagic shock.
• Surgical shock.
• Traumatic shock.
• Burn shock.
• Shock of fluid (vomiting).
• Management: Replace the loss
by suitable
fluid
 Cardiogenic Shock
• Heart fails in its job as a
pump.

• Causes:
• Acute heart failure
• Acute myocardial
infraction.
• Arrhythmias.

• Management :
• according to the cause.
 Distributive Shock
• There is peripheral vasodilatation that will
reduce both venous return and BP.

• Subdivided according to the cause into:

• Neurogenic shock.
• Septic shock.
• Anaphylactic shock.
 Neurogenic Shock
• Severe traumatic pain in
certain sites can cause
vasovagal attacks which
will lead to the shock.
• Causes:
• Severe pain
• Spinal shock
• Anesthesia
• Management:
supportive treatment
and
vasoconstrictive drugs.
 Anaphylactic Shock
• Acute vasodilatation due
to immediate
hypersensitivity reaction
which release vasoactive
substances like histamine.
• Causes:
• insect bite
• food \ drug allergy
• blood transfusion
• Management: as in
neurogenic shock plus
antiallergic drugs.
 Obstructive shock
• Occurs due to
obstruction of blood flow
within the chest.
• Causes :
• Anything can lead to
kinking of aorta or
interruption of pulmonary
blood flow like e.g
pulmonary embolism.
 Symptoms & signs
Symptoms: Sign:

• Palpitations. • Tachycardia
• Thirst. • Hypotension
• Irritability. • pale and cold
extremities
• Sweeting.
• Hyperventilation.
• Low urine out put.