Anatomy and Physiology To understand what occurs in heart failure, it is useful to be familiar with the anatomy of the heart

and how it works. The heart is composed of two independent pumping systems, one on the right side, and the other on the left. Each has two chambers, an atrium and a ventricle. The ventricles are the major pumps in the heart.

The external structures of the heart include the ventricles, atria, arteries, and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide. The Right Side of the Heart The right system receives blood from the veins of the whole body. This is "used" blood, which is poor in oxygen and rich in carbon dioxide.

The right atrium is the first chamber that receives blood. The chamber expands as its muscles relax to fill with blood that has returned from the body.

The blood enters a second muscular chamber called the right ventricle. The right ventricle is one of the heart's two major pumps. Its function is to pump the blood into the lungs.

The lungs restore oxygen to the blood and exchange it with carbon dioxide, which is exhaled.

The Left Side of the Heart The left system receives blood from the lungs. This blood is now oxygen rich.

The oxygen-rich blood returns through veins coming from the lungs (pulmonary veins) to the heart.

It is received from the lungs in the left atrium, the first chamber on the left side. Here, it moves to the left ventricle, a powerful muscular chamber that pumps the blood back out to the body.

The left ventricle is the strongest of the heart's pumps. Its thicker muscles need to perform contractions powerful enough to force the blood to all parts of the body.

This strong contraction produces systolic blood pressure (the first and higher number in blood pressure measurement). The lower number (diastolic blood pressure) is measured when the left ventricle relaxes to refill with blood between beats.

Blood leaves the heart through the ascending aorta, the major artery that feeds blood to the entire body.

The Valves Valves are muscular flaps that open and close so blood will flow in the right direction. There are four valves in the heart:

The tricuspid regulates blood flow between the right atrium and the right ventricle.

The pulmonary valve opens to allow blood to flow from the right ventricle to the lungs.

The mitral valve regulates blood flow between the left atrium and the left ventricle.

The aortic valve allows blood to flow from the left ventricle to the ascending aorta.

The Heart's Electrical System. The heartbeats are triggered and regulated by the conducting system, a network of specialized muscle cells that form an independent electrical system in the heart muscles. These cells are connected by channels that pass chemically caused electrical impulses.

Pathophysiology

Predisposing Factor: Age gender

Precipitating Factor:
Sedentary Lifestyle Diet Tobacco Life History of stroke

Decreased elasticity of blood vessels and formation of plaques on blood vessels

Narrowing of the blood vessels

Necrosis and scarring of the vascular endothelium

Impediment of blood flow to the body

Increased workload of the heart

Dilation of the ventricles

Increased Preload

Increased stretching of the myocardial muscle

Excessive stretching of the myocardial muscle A

Ineffective cardiac contraction and increase O2 demand of cardiac muscle cells

Decreased contraction of cardiac muscle

Decreased cardiac output and systemic perfusion

Activation of neurothermal pathways in order to increase circulating blood vessels

Continued neurohormonal stimulation

Cardiac Remodelling

Decreased blood filling

Increased stroke volume and Decreased cardiac output

Inadequate perfussion

Increased wall tension

Pallor

Decreased blood flow to the kidneys

Decrease perfusion in the coronary arteries

Increase Pulmonary Pressure

Kidneys Produces hormones

Deprivation of cardiac muscles of nutrients needed for survival

Fatigue and weakness

Salt and water retention

Normal balance between oxygen supply and demand is disrupted

Edema Ischemia

Conversion of aerobic metabolism to anaerobic metabolism

Causes reduce contractility

Decreased adenosine

Lactic acid prod. Decrease Cardiac output Irritation of myocardiac cells

Bradycardia

Chest Pain

Separation of mitral valves leaflets

Increase pulmonary pressure

Impaired left ventricular relaxation

Increase diastolic pressure exceeding hydrostatic and osmotic pressure in pulmonary capillaries

Increased capillary pressure in the lungs

Fluid shifts from the circulating blood into the interstitium, bronchioles, bronchi and alveoli

Decreased lung expansion

Increased capillary pressure in the lungs

Dsypnea

Bilateral Crackles

Fluid trapped in pulmonary trees