Escolar Documentos
Profissional Documentos
Cultura Documentos
FAILURE
CLINICAL PRESENTATION
Breathlessness (Dyspnea) : Orthopnea,
Paroxysmal nocturna dyspnea
Hemoptysis
Chest pain
Fatique
Nocturia
Confusion
Etiology
Inappropriate workloads placed on heart,
such as volume overload or pressure
overload
Restricted filling of the heart
Myocyte loss
Decreased myocyte contractility
Hemodynamic Changes
Systolic Dysfunction
Isovolumic systolic
pressure curve of
the pressurevolume
relationship is
shifted downward
This reduces stroke volume reduces
cardiac output
To maintain cardiac
output, heart respond
with three compensatory
mechanisms: First,
increased return of
blood to the heart
(preload) can lead to
increased contraction of
sarcomeres (FrankStarling relationship).
In the pressure-volume relationship, the heart
operates at a' instead of a, and stroke volume
increases,
Second, increased
release of
catecholamines can
increase cardiac
output by both
increasing the heart
rate and shifting the
systolic
isovolumetric curve
to the left
Diastolic Dysfunction
In diastolic dysfunction, the
position of the systolic
isovolumic curve remains
unchanged (contractility of
the myocytes is preserved).
The diastolic pressure-volume
curve is shifted to the left,
with an accompanying
increase in left ventricular
end-diastolic pressure and
symptoms of congestive
heart failure
NEUROHUMORAL CHANGES
Initially, increased activity of the adrenergic
system and the renin-angiotensin system
provides a compensatory response that
maintains perfusion of vital organs.
Over time these changes can lead to
progressive deterioration of cardiac function.
Increased sympathetic activity occurs early in
the development of heart failure.
CELLULAR CHANGES
delivery of Ca2+ to the contractile apparatus
and reuptake of Ca2+ by the sarcoplasmic
reticulum are slowed.
levels of 1 adrenergic receptors are
slightly increased myocardial hypertrophy
significant -adrenergic receptor
desensitization as a result of chronic
sympathetic activation.
Patophysiology
Patients with isolated right ventricular failure
(pulmonary hypertension, cor pulmonale) can
have a mechanical reason for left ventricular
failure
When right ventricular pressure increases
relative to the left, the interventricular septum
can bow to the left and prevent efficient filling of
the left ventricle, which may lead to pulmonary
congestion.