PATHO/PHYSIO OF ACUTE DECOMPENSATED HEART FAILURE

PRECIPITATING FACTORS PREDISPOSING FACTORS

ISCHEMIC HD , LIFESTYLE, OBESITY,

HYPERTHYROIDISM, MI, AGE, NON ADHERENCE
VALVULAR DISEASE, TO MEDICATIONS
HYPERTENSION

↓CO, ↓SYSTEMIC BP, ACTIVATION OF

↓ PERFUSION TO THE MYOCARDIAL DYSFUNCTION BARORECEPTORS
KIDNEY

STIMULATION OF
ACTIVATION OF RAAS VASOMOTOR RECEPTORS IN
MEDULLA

Na & H20 RETENTION

ARGININE VASOPRESSIN ACTIVATION OF SNS
VASOCONSTRICTION
ENDOTHELIN
N
CYTOKINES
↑CATECHOLAMINES
↑AFTERLOAD
(NOREPINEPHRINE,
↑BP ↑HR
EPINEPHRINE)

VENTRICULAR
REMODELING

HYPERTROPHY AND
↓CORONARY DILATION OF VENTRICLE,
PERFUSION IMPAIRED CONTRACTILITY

MYOCARDIAL ISCHEMIA CARDIAC DYSFUNCTION

TACHYCARDIA ↑MVO2

↓CORONARY CARDIAC DYSFUNCTION

MYOCARDIAL ISCHEMIA
PERFUSION
↑LV AFTERLOAD

↓CO/ ↑LVEDP SYSTOLIC DISATOLIC

END-ORGAN RENAL LUNG ↑LV WALL STRESS

HYPOPERFUSION DYSFUNCTION CONGESTION
HEMODYNAMIC
↑VENOUS DECOMPENSATION
PRESSURE ↑LV PRELOAD

ACTIVATION OF RAAS-SNS-ADH
Na, H20 RETENTION
(INFLAMMATORY ACTIVATION)
CONGESTION
↓CO

DIURETIC RESISTANCE

CELLULAR DAMAGE END-ORGAN DYSFUNCTION WORSENING VOLUME OVELOAD

MORBIDITY/MORTALITY