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Contractility
Shift entire ventricular
function curve upward & left
Contractility
Shift entire ventricular
function curve downward &
right
Ischemia
Hypoxia
Acidosis
Inflammation
Toxins
Metabolic disorders
Cardiomyopathies
Systemic hypertension
Myocarditis
Pulmonary hypertension
Coronary insufficiency
Coarctation of aorta
MI
Volume work
Valvular heart disease
A-V shunt
Stenotic
Excessive IV infusion
Regurgitation
Perfusion work
Congenital heart disease
Thyrotoxicosis
Constrictive pericarditis
Anemia
Causes of HF in Adults
Most common
Coronary heart disease
Hypertension
Slightly common
Idiopathic dilated
cardiomyopathy
Valvular heart disease
Diabetic cardiomyopathy
Frank-Starling mechanism
Sympathetic activity
RAA mechanism
Myocardial hypertrophy
IHD
requirem.
Cardiomyopathies
Chronic metabolic rate
(eg. thyrotoxicosis)
O2 carrying capacity of
blood
(eg. anaemia)
A-V shunting
(eg. A-V fistula)
Systolic/ Diastolic Dysfunction
Systolic
Diastolic
Defect in ventricular
Impaired ability in ventricular
contraction
filling
Left ventricles lose ability to
Filling
generate enough pressure to
Stroke volume
eject blood forward through
Congestive symptoms tend to
pressure aorta
predominate
( ejection fraction)
IHD
Mitral stenosis
Cardiomyopathy
Myocardial hypertrophy
Valvular regurgitation
IHD
Anaemia
Hypertension
Valvular stenosis
Most cases are mixed Systolic & Diastolic Dysfunction
Peripheral edema
Hepatomegaly
Splenomegaly
Vascular congestion of
GIT
Stenosis/ regurgitation of
tricuspid & pulmonic
valves
RV infarction
Cardiomyopathy
Tachycardia
Sweating
Gallop rhythm
Moist crepitations
Pleural effusion
Caused by
Acute myocardial
infarction
Cardiomyopathy
Respiratory Manifestations
SOB caused by congestion of pulmonary circulation (left-sided
HF)
Dyspnea
Due to bronchospasm
Mental confusion
Memory impairment
Anxiety
Restlessness
Insomnia
Cardiac Cachexia
Malnutrition & tissue wasting
End-stage heart failure
Contributing factors
Heart failure
Delivery of poorly
Lung diseases
oxygenated blood to
Right-to-left shunts
peripheral tissues
Peripheral
vasoconstriction
Complications of Heart Failure
Cardiac arrhythmias (eg. atrial fibrillation, ventricular
arrhythmias)
Pulmonary embolism (due to DVT)
Mural thrombosis (in dilated heart chambers)
Chest infection (due to chronic pulmonary congestion)
Major organ failure (MOF) (eg. renal impairment, cardiac
cirrhosis)
Diagnosis of Heart Failure
Signs & Symptoms
Basic investigations
ECG
CXR
Blood Test
Other important investigations
Echocardiogram