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Heart Failure
Heart Failure
Heart Failure
Although a host of diseases can affect the
cardiovascular system, the pathophysiologic
pathways that result in a broken heart
distill down to six principal mechanisms:
Failure of the pump. In the most
common situation, the cardiac muscle
contracts weakly and the chambers cannot
empty properlyso-called systolic
dysfunction
HEART FAILURE
Most cases of heart failure are due to
systolic dysfunctioninadequate
myocardial contractile function,
characteristically a consequence of
ischemic heart disease or hypertension.
Alternatively,
CHF also can result from diastolic
dysfunctioninability of the heart to adequately
MORPHOLOGY
which is associated with an increased incidence of
atrial fibrillation.
Clinical Features
Orthopnea typically is relieved by sitting
or standing, so patients usually sleep in a
semi seated position.
Paroxysmal nocturnal dyspnea is a
particularly dramatic form of
breathlessness, awakening patients from
sleep with extreme dyspnea bordering on
feelings of suffocation.
Other manifestations of left ventricular
failure include an enlarged heart
(cardiomegaly), tachycardia, a third heart
sound (S3), and fine rales at the lung
bases, caused by the opening of
edematous pulmonary alveoli.
Right heart failure usually is the
consequence of left-sided heart failure,
since any pressure increase in the
pulmonary circulation inevitably produces
an increased burden on the right side of
the heart.
Isolated right-sided heart failure also
can occur in a few diseases.
MORPHOLOGY
When left-sided heart failure is also
present,severe central hypoxia produces
centrilobular necrosis in addition to the
sinusoidal congestion.
With long-standing severe right-sided
heart failure, the central areas can
become fibrotic, creating so-called
cardiac cirrhosis.
Right-sided heart failure also leads to
elevated pressure in the portal vein and its
tributaries (portal hypertension), with
vascular congestion producing a tense,
enlarged spleen
(congestive splenomegaly).
Chronic passive congestion of the bowel wall
with edema can be severe enough to
interfere with absorption of nutrients and
medications
Pleural,Pericardial, and
Peritoneal Spaces.
Systemic venous congestion due to right heart failure can
lead to transudates (effusions) in the pleural and
pericardial spaces, but usually does not cause pulmonary
parenchymal edema.
Clinical Features
Of note, in most cases of chronic cardiac
decompensation, patients present with
biventricular CHF, encompassing the clinical
syndromes of both right-sided and left-sided heart
failure.