CHF What is CHF? Fix the underlying problem Heart is a 2 sided pump Both sides can fail independent of each other.
CHF What different types of pathophysiology cause it? Systolic Dysfunction Diastolic Dysfunction High Output States
CHF Systolic Dysfunction – What is it? Is it only related to events that occur in Systole? -1. Decreased Contractility - a. Loss of Myocytes - b. Over-stretched Heart -2. Increased Afterload - a. Increased BP - b. Stenotic Valve - Pulmonic Valve and carcinoid syndrome – 5HIAA
CHF Diastolic Dysfunction – What is it? –1. Impaired Relaxation –2. Obstruction to filling Can systolic and diastolic functions coexist?
CHF Pressure volume loops are used to distinguish between systolic vs. diastolic dysfunction
CHF High Output States – What is it? –Paget’s Disease –Anemia –Thiamine Deficiency –Hyperthyroidism
CHF The failing heart and how it compensates –What does a failing heart mean, and what is decompensation? What does a failing heart look like? –Compensations made by a failing heart Frank Starling Forces Neuro-Hormonal Changes Ventricular Remodeling
CHF Compensations Acute R sided failure –Causes? –Would you expect to see any change to the R ventricle?
CHF Compensations R sided failure symptoms from the backing up of blood: –Pitting Edema –JVD –GI discomfort –Liver congestion RUQ pain Hepatojugular Reflex Ascites – Puddle sign
CHF complications Would you expect someone with R sided failure only, that is, no L sided failure, to have pulmonary hypertension or pulmonary edema?
CHF Compensations Neurohormonal changes: –Renin-Angiotensin System –Adrenergic System –ADH
CHF Compensations Renin-Angiotensin System – raise EABV, and lower plasma oncotic p.
CHF Compensations Does the Renin-Angiotensin System restore EABV back to normal? Why is this harmful in the end?
CHF Compensations Adrenergic System: –Increased Sympathetic outflow –Increased effects of epinephrine on adrenergic receptors throughout your body –What pathological process could keep the adrenergic system on even if the EABV is restored?
CHF Compensations Does the adrenergic system restore the EABV? Why is this harmful in the end?
CHF Compensations ADH secretion –Why do its effects become blunted in long run?