Insuficiencia cardiaca

Dr. Ricardo Armisen Y

ICBM
Facultad de Medicina
Universidad de Chile
 Referencias

•Harrison, Principles of Internal Medicine, 2007

•Porth, Pathophisiology, 2006
•Lilly, Pathophysiology of Heart Disease: A Collaborative
Project of Medical Students and Faculty, 2007
•Ashley & Niebahuer, Cardiology Explained, 2004
Heart Failure
¥ Function of the heart
Ð Move deoxygenated blood from the venous system
through the right heart into the pulmonary circulation
Ð Move the oxygenated blood from the pulmonary
circulation through the left heart into the arterial
system
¥ Right and left heart must maintain an equal output
to function properly
Right Heart Failure
¥ Represents failure of the right heart to pump blood
forward into the pulmonary circulation
Ð Blood backs up in the systemic circulation
¥ Causes peripheral edema and congestion of the
abdominal organs
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¥ Acute myocardial infarction
¥ Hypertension
¥ Degenerative conditions of the heart muscle known
collectively as cardiomyopathies
¥ Excessive work demands (hypermetabolic states)
¥ Volume overload (renal failure)
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Maintenance of Cardiac Reserve in Heat
Failure
¥ Compensatory or adaptive mechanisms
Ð Frank-Starling mechanism
Ð Activation of neurohumoral influences such as the
sympathetic nervous system
Ð The renin-angiotensin-aldosterone mechanism
Ð Natriuretic peptides
Ð Locally-produced vasoactive substances
Ð Myocardial hypertrophy and remodeling
Causes of Right-Sided Heart Failure
¥ Conditions that restrict blood flow into the lungs
¥ Stenosis or regurgitation of the tricuspid or pulmonic
valves
¥ Right ventricular infarction
¥ Cardiomyopathy
¥ Persistent left-sided failure
¥ Acute or chronic pulmonary disease (cor pulmonale)
Manifestations of Heart Failure
¥ Physiologic effects of the impaired pumping ability of the
heart
¥ Decreased renal blood flow
¥ Activation of the sympathetic compensatory mechanisms
Signs and Symptoms of Heart Failure
¥ Fluid retention and edema
¥ Shortness of breath
¥ Fatigue and limited exercise tolerance
¥ Cyanosis
¥ Cachexia and malnutrition
¥ Distention of the jugular veins in right-sided failure
¥ Diaphoresis and tachycardia
Acute Pulmonary Edema
¥ Capillary fluid moves into the alveoli, causes lung
stiffness, makes lung expansion more difficult, and
impairs the gas exchange function of the lung
¥ With the decreased ability of the lungs to oxygenate the
blood, the hemoglobin leaves the pulmonary circulation
without being fully oxygenated
Ð Results in shortness of breath and cyanosis
P = T/r
T is wall tension
P is the intraluminal pressure
r is vessel radius

T = P × r/wall thickness