PATHOPHYSIOLOGY OF HEART FAILURE

Predisposing factors Age: 58 y.o. Heredity Gender Precipitating factors History of Asthma Diet (high Na intake) Smoking Alcohol Drinking COPD Inc. blood viscousity

Inc. (peripheral) vascular resistance

Inc. Afterload

Inc. L. ventricular workload Chest X-ray: Cardiomegaly

Creatinine
52 umol/L

Decrease blood flow to kidneys

Ventricular dilation

Prompts kidneys to secrete renin

Inc. CO

Inc. Wall stress

Hyperplasia Angiotensinogen (from Liver) Inc. O2 requirement Angiotensin 1 Remodelling

A. Converting Enzyme (Lungs)

Inc. force & rate of contraction

O2 via nasal cannula

Dec. contractility Low O2

Vasoconstriction

Angiotensin 2 Sympathetic activation Aldosterone release Inc. tubular Na reabsorption Pale extremities (jaundice) Irregular pulses Jugular vein distention

Inc. cell death

H2O conservation

Osmotic fluid reabsorption

Dec. ventricular contraction

Dec. capacity to receive blood from L. atrium

Inc. amount of blood in L. ventricle

Digoxin

Blood goes back to L. atrium

Inc. L. atrial workload

Atrial dilation, remodeling, sympathetic activation

Inc. L. atrial pressure

Inability to receive full pulmonary blood Inc. R. ventricular workload

Inc. pulmonary pressure

Fluid movement from interstitium to alveoli

R. ventricular dilation, remodeling, sympathetic activation

Dec. capacity to receive blood from R. atrium

Blood goes back to R. atrium LEFT Manifestations SOB RR-23 cpm Productive cough Stridor and crackles Pale extremities (jaundice) Body weakness Exhausted facie Inc. R. atrial workload

Atrial dilation, remodelling, sympathetic activation

Backward flow of blood from systemic circulation

Systemic congestion

Inability to receive full systemic blood

Spironolactone & Furosemide RIGHT Manifestations Bipedal edema Distended Jugular neck veins @ 45 degree position Anorexia

Inc. Preload

Lactulose & Dolculax

Legend:
Phenomenon Manifestations

Treatment