PATHOPHYSIOLOGY

Heart Damage

Ventricular Overload

Decreased Ventricular Contraction

Tachycardia
Fluid Overload
Ventricular Dilatation
Edema
Myocardial Hypertrophy

Increased Water Reabsorption

Decreased Cardiac Output

Decreased Renal Perfusion

Increased ADH

Increased Sodium Retention Increased Osmotic Pressure

 Right ventricular failure occurs when the right ventricle is unable to pump blood into the
pulmonary circulation. Less blood is oxygenated and pressure increases in the right atrium and
systemic venous circulation, which results in edema of the extremities.
 Left ventricular failure occurs when the left ventricle in unable to pump blood into systemic
circulation. Pressure increases in the left atrium and pulmonary veins; then the lungs become
congested with blood, causing elevated pulmonary pressure and pulmonary edema.
 To compensate, the cardiac muscle hypertrophies eventually resulting in decreased
ventricular compliance. Decreased compliance requires higher filling pressure to produce the
same stroke volume. Increased muscle mass impedes oxygenation of the heart muscle, which
leads to decreased contraction force and heart failure.
 As cardiac output fails, stretch receptors and baroreceptors stimulate the sympathetic
nervous system, releasing catecholamines that increase the force and rate of myocardial
contraction.
 This causes increased systemic resistance, increased venous return, and reduced blood flow to
the limbs, viscera and kidneys.
 Sweating results from sympathetic cholinergic fibers, there is extra work for the heart muscle,
and there is less systemic blood flow.
 The renal system responds by releasing renin-angiotensin, which sets off a chain of events –
vasoconstriction, leading to increased aldosterone release, causing sodium and water
retention and, in turn, increasing preload. Finally, sodium and water retention becomes
excessive, resulting in signs of systemic venous congestion and fluid overload.