CARDIAC FAILURE

Dr. Mehzabin Ahmed

 Heart failure

Cardiac failure develops when the

heart cannot maintain the circulation

The pumping action of the heart fails

to keep up to the requirements of
the body
Types
Acute:
Abrupt failure of the chamber to empty resulting in dilatation
of the chamber.
Too quick- thus any compensatory mechanism cannot operate
Patient is in circulatory collapse with low blood pressure-
‘Cardiogenic Shock’
Chronic:
Longer course with a gradual increase in the severity of the
underlying heart disease
Compensatory responses like
 hypertrophy of the cardiac muscle,
 constriction of the arterioles,
 activation of the sympathetic and the renin angiotensin
system
Chronic failure - hypertrophy Acute failure-
dilatation of
of the walls the chambers

Hypertrophied heart-
thick walls and
narrowed cavity
Causes of heart failure

Left heart failure Right heart failure

Acute Cor Pulmonale -
Ischemic heart disease Pulmonary embolism
Hypertension Chronic Cor Pulmonale-
Valvular heart disease- Chronic lung disease
 Aortic valve diseases
(obstructive or restricitive
lung diseases)
 mitral valve diseases
Pulmonary Vascular Disease
Myocardial diseases
Chronic left heart failure
Valvular Disease
 Pulmonic or Tricuspid
Left heart failure
Left heart fails to pump effectively
 Chambers fail to empty completely at systole and
thus dilate
 Rise in the pressure in left ventricle results in the
increased pressure in the atrium and the vessels
that drain into the left atrium (pulmonary veins
and therefore the pulmonary capillaries)
 This increase in the capillary pressure
(hydrostatic) results in fluid collection in the
alveoli- ‘Pulmonary Edema’
 It also leads to poor systemic perfusion, as
insufficient blood is pumped into the aorta and the
arterial system.
Consequences of LHF In pulmonary edema the alveoli are
filled with pink edema fluid

Normal lung

Pulmonary edema- dyspnoea, cough

with production of pink frothy sputum.
Poor output- hypotension, poor tissue
perfusion and oxygenation- kidneys
may be affected resulting in renal
failure and brain may suffer from
hypoxia
Repeated episodes of left heart failure
or chronic cases results in brown
induration of the lung- long standing
congestion of the pulmonary
vasculature results in accumulation of
abundant numbers of hemosiderin Chronic venous congestion of the lung
fibrosis of the alveolar hemosiderin laden
(brown pigment) laden macrophages septae- firm, indurated macrophages-
Right heart failure

As the right heart fails the right ventricle

dilates and increases the intra ventricular and
then the intra atrial pressure.
 Thus the systemic veins (vena cavae) that
empty blood into the right atrium are
congested resulting in the increase in the
systemic venous pressure.
 Also leads to poor perfusion of the lungs
Consequences of the RHF
Raised pressure in the superior vena cava
 raised jugular venous pressure Edema is seen in the lower
limbs and dependent parts of
Raised pressure in the inferior vena cava the body

 chronic venous congestion in the portal

circulation – hepatosplenomegaly and an
enlarged congested liver- Nutmeg liver

 congestion of the systemic circulation

results in

- edema of the lower limbs,

- effusions like pleural effusions,

ascites

Azotemia Nutmeg liver- alternate dark (areas of necrosis and

congestion) and light ( areas of fatty change) regions
Cerebral hypoxia (Encephalopathy
Congestive cardiac failure

Failure of both left and right side of the heart.

Usually starts as left heart failure (longstanding
& severe)

Pulmonary congestion and increase in the
pressure in the pulmonary.capillaries


Increased back pressure in the pulmonary
arterial system causing increase in the resistance
of the pulmonary arterioles


Right heart failure is caused due to the right
heart having to pump against this increased
resistance
 Cardiac failure- when the heart fails to
pump blood adequately

Types Causes Consequences

Left sided heart Diseases of the Pulmonary Edema &

failure heart & blood Brown induration of the
vessels lung

Right sided heart Lung diseases & Systemic congestion-

failure Left heart failure Subcutaneous edema &
pleural effusion
Portal congestion-
Nutmeg liver and
ascites
At the end of the lesson on Cardiac failure, the
student should be able to:
Define cardiac failure.
Enumerate the conditions that can lead to
congestive cardiac failure.
Enumerate the etiological conditions of pure
left heart failure, pure right heart failure.
Enumerate the extracardiac manifestations of
left heart & right heart failure.
Explain the pathogenesis of extracardiac
manifestations of left heart & right heart
failure.