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Blood pressure regulation
Cardiac output vs stroke volume
Heart failure is pathophysiology State in which heart, via an abnormality of cardiac functions fail to pump blood
Common end point for cardiac disease
Increased demand ie anemia, hypothyroidism
Abrupt or gradual
Systolic or diastolic dysfunction
Common in older adults, diabetic patients and women
Systolic dysfunction
Systole is ejection phase
Aortic and pulmonary valve open AV valves close
Leads to inadequate myocardum pump dysfunction
Causes
CAD
Valvular heart diseases
Arrythmias lead to reduced pumping
Infections and inflammation
Congenital heart disease-
Idiopathic cardiomyopathy
Drugs
Peripartum cardiomyopathy
Diastolic dysfunction
Period of ventricular filling
AV valves open
Diastolic dysfunction is inability to fill
Left ventricular hypertrophy
Myocardial fibrosis
Amyloid deposition
Constrictive pericarditis
Hypertrophic and restrictive cardiomyopathy
Valvular heart disease ie aortic stenosis
Effects of pump failure
Increased end diastolic volume
Increased end diastolic pressure
Elevated venous pressure
Forward failure - inadequate output
Backwards failure - increased venous congestion
Compensatory mechanism
Frank starling mechanism
Cardiac output increases or decreases in response
Lead to compensated heart failure or decompensated heart failure
Activation of neurohurmoral system
Release of norepinephrine, renin angiotensin system
Myocardial structural changes
Cardiac myocytes adapt to increased workload by adding sarcomeres, Cardiac hypertrophy
Left sided heart failure
LV no longer pumps enough blood to body, blood build's up in pulmonary veins
IHD
Systemic hypertendion
Mitral and Aortic valve diseases
Primary disease-of myocardion
Morphology
Heart
Depends on underlying cause
Areas of myocardial infarction
Valvular deformities
Endomycardial fibrosis in restrictive cardiomyopathy
Left ventricular hypertrophy and dilatation
Microscopic -, myocyte hypertrophy, interstitial fibrosis, areas of coagulative necrosis in MI
Lungs
Congestion and edema
Olura effusion due to increased hydrostatic pressure
Heavy and boggy
Microscopic - Perivascular and interstitial transudate, alveolar septal edema,
Heart failure cells - hemosiderin laden macrophages
Clinical features
Dyspnea on exertion
Cough due to fluid transudation into air spaces
Orthopnea- dyspnea when recumbent
Paroxysmal nocturnal dyspnea
Cardiomegaly
Tachycardia
Third heart sound S3
Fine rales at lung bases
Papillary muscle displacements causing mitral valve regurgitation
Atrial fibrillation as irregularly irregular sounds
Stasis of blood due to atrial fibrillation
Pre renal azotemia due to decreased renal perfusion
Hypoxic encephalopathy
Treatment
Correct underlying cause
Salt restrictions
Pharmacologic agent's to reduce overload, increase contractility, reduce after load
Right sided heart failure
RV too weak to pump blood to lungs
Blood fills up in veins
Consequence of Left sided heart failure
Cor pulmonale is isolated Left side heart failure in patients with certain lung disorders
Causes similar in Left sided heart failure
Causes of Cor pulmonale
Parenchyma lung diseases
Pulmonary vasculature disorders
Myocardial hypertrophy and dilatation
Bulging of ventricular septum
Engorgement of systemic and portal venous sustem
Liver and portal system
Congestive hepatosplenonegaly
Nutmegs liver
LSHF present with centrilobular necrosis due to central hypoxia
Elevated pressure in portal vein with congestive splenomegaly
Severe congestion and edema can compromise absorption
Pleural, Pericardial and peritoneal spaces
Effusion in these space
Pleural effusion more pronounced
Ascites
Are transudates with low protein system with no inflammatory cells
Subcutaneous tissues
Edema at feet, lower legs( Hallmark
Presacral edema in clinically Ill patient
Pure right sided heart faiilur
Venous congestion and hypoxia in kidney and brain
Pleural effusion
Patient may become cyanotic if it progress
New York heart association
Grade 1(,mild),2(mild), 3 (moderate),4(severe)
Diagnosis/ Framingham diagnostic criteria
Major
Acute pulmonary edema
Hepatojugular reflex
Cardiac tumors
Majority benign
Primary
Myxoma
Fibroma
Lipomas
Papillary fibroelastoma
Most common
Left atrium common
Single
Arise in atrial septa
Mean age 50 years
Histology- stellate, multinucleated myxoma cells admixed with endothelial smooth muscle cells
Arise from mesenchymal
Cells embedded in acid
Rhabdomyoma
More in children less than 1yr of age
Obstruction of valvular orifice
Associated with congenital heart disease-
Valvular obstruction
Embolization
Grey white masses
Mixed population of cells:spider cells with numerous glycogen laden vacuoles
Cardiac fibroma
Common in children
Present with heart failure or cyanosis , syncope or arrythmias, asymptomatic
Discrete bulging mas
Microscopic- bland fibroblast and collagen
Benign papillary growth of endocardium
KRAS mutation
Male than female
Risk
Damaged endothelial
Microscopic- multiple branching friends of paucicellular avascular tissue
Cardiac effects of non cardiac neoplasm
Metastasis
Effects of circulating mediators
Therapeutic mediators complications
From lung, breast, melanoma, leukemia and lymphomas,
Occur by retrograde lymphatic spread
Associated with Pericardial spread
Superior Vena cava symptom
Non bacterial ylthrombotic Endocarditis
Carcinoid heart disease
Pheochromocytoma
Myeloma
Effects of treatment
Dilated cardiomyopathy by doxorubicin
Pericarditis by radiation treatment of breast cancer
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