Presentation on theme: "HEART FAILURE (HF) Heart failure is the pathophysiological state in which an abnormality of cardiac function is responsible for failure of the heart to."— Presentation transcript:
1HEART FAILURE (HF)Heart failure is the pathophysiological state in which an abnormality of cardiac function is responsible for failure of the heart to pump blood at a rate commensurate with the requirements of the metabolizing tissue, or to do so only from an elevated filling pressure.Clinical syndrome due to different structural and functional disease of the heart leading to abnormality in filling or emptying of the left ventricle.
2Myocardial insufficiency – related to impaired contractility Myocardial insufficiency – related to impaired contractility. Not every heart failure is associated with myocardial insufficiency.Circulatory failure – clinical syndrome which is caused by abnormality of the following components of circulation, such as the heart, blood volume, Hb level, vessels.
4Early adaptive mechanisms Frank-Starling mechanismActivation of neurohormonal systems
5NEUROHORMONAL MECHANISMS Elevation of norepinephrine leading to increased contractility.Activation of renin-angiotensin-aldosterone system (RAAS).Activation of arginine-vasopressin system.Activation of natriuretic peptides (ANP, BNP, CNP).Elevation of endotheline.Elevation of cytokines (TNF-α, IL-1β).NO (NO synthethase –NOS1-3).Elevation of oxidative stress in the myocardium.
6LATE ADAPTIVE MECHANISMS Left ventricular remodeling
7Parallel arrangement of sarcomers Pressure overloadVolume overload↑ Systolic strain↑ Diastolic strain↑ Activation of extracellular and intracellular signalsLeft ventricular remodelingParallel arrangement of sarcomersSerial arrangement of sarcomersConcentric hyperthrophyExcentric hyperthrophyNormal
8Framingham criteria for HF Major criteriaParoxyzmal nocturnal dyspnoeNeck-vein distensionRalesCardiomegalyAcute pulmonary edemaS3 gallop↑ venous pressure(16 cm H2O)Hepatojugular refluxLoss of weight > 4,5 kg during 5 daysMinor criteriaAnkle edemaNight coughDyspnoe on exertionHepatomegalyPleural effusionTachyaardia (>120/min.)
9FORMS OF HF Right-sided vs left-sided HF Acute vs chronic HF Low-output vs high-output HFSystolic vs diastolic HF
10Causes of HFPericardial disease (tamponade, constrictive pericarditis)Valvular heart diseaseDisease of the myocardium (dilated CMP)Coronary heart diseaseArrhythmias (tachycardia-induced CMP)