HEART FAILURE

Definition :
The heart is unable to pump blood at a rate
that meets the requirements of the
metabolizing tissues, or can only do so only
with filling pressures that are higher than
normal.
May be insidious or acute.
Occur as consequence of :
1.Systolic dysfunction, the progressive
deterioration of myocardial contractile function
is commonly due to ischemic heart disease or
hypertension.
2.Diastolic failure occur in elderly and more
likely to be female with hypertension or diabetes
mellitus.
Causes:
1.Valve failure (e.g., endocarditis).
2.Abnormal load (e.g., fluid or pressure
overload).
The adaptive mechanisms:
a.Activation of neurohumoral systems:
(1) Release of norepinephrine by the
sympathetic nervous system.
(2) Activation of the renin-angiotensin-
aldosterone system.
(3) Release of atrial natriuretic peptide (ANP).
b.The Frank-Starling mechanism:
As cardiac failure progresses, end-diastolic
pressures increase, causing individual cardiac
muscle fibers to stretch; this ultimately
increases the volume of the cardiac chamber,
these lengthened fibers initially contract more
forcibly, thereby increasing cardiac output.
Compensated heart failure:
If the dilated ventricle is able to maintain
cardiac output at a level that meets the needs
of the body, the patient is said to be in
compensated heart failure.
Decompensated heart failure:
With time, the failing myocardium is no longer
able to propel sufficient blood to meet the
needs of the body, even at rest.
At this point, patients enter a phase termed
decompensated heart failure.
Left-sided cardiac failure :
Common causes:
(1) IHD.
(2) systemic hypertension.
(3) mitral or aortic valve disease.
(4) primary diseases of the myocardium.
Right-sided heart failure :
The most common causes:
1. left ventricular failure, with its associated pulmonary
congestion and elevation in pulmonary arterial pressure.
2. Intrinsic diseases of the lung parenchyma and/or
pulmonary vasculature (cor pulmonale) and in patients
with primary pulmonic or tricuspid valve disease.
3. Congenital heart diseases, i.e., in the setting of left-to-
right shunts with chronic volume and pressure overloads.
Clinical Features:
1.Dyspnea (breathlessness).
2.Cough is due to fluid transudation into
airspaces.
3. Dyspnea when recumbent (so-called
orthopnea). Orthopnea is typically relieved by
sitting or standing.
4.Paroxysmal nocturnal dyspnea.
4.Enlarged heart (cardiomegaly).
5.Tachycardia.
6.Third heart sound (S3).
7.Fine rales at the lung bases.
8.With progressive ventricular dilation, the
papillary muscles are displaced laterally,
causing mitral regurgitation and a systolic
murmur.
9. Subsequent chronic dilation of the left
atrium is often associated with atrial
fibrillation, manifested by an "irregularly
irregular" heartbeat.