09-CARDIAC-FAILURE.presentation slidesss

Medicine

1. CARDIAC FAILURE
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CARDIAC FAILURE
TOPICS
INTRODUCTION
CAUSES
LEFT HEART FAILURE
RIGHT HEART FAILURE
CONGESTIVE CARDIAC FAILURE
DIAGNOSIS
DYSPNOEA
AGE EFFECTS
HIGH OUTPUT FAILURE
Brian Angus Pathology Department
University of Newcastle upon Tyne
Return to Cardiovascular
Pathology Index Page

2. CARDIAC FAILURE
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INTRODUCTION
•very common clinical
problem
•due to many types of
cardiac disease
•prognosis poor -
median survival 3 yrs

3. CARDIAC FAILURE
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SIDE OF HEART
AFFECTED
The heart works as a unit with both
ventricles contracting in unison. Heart
failure usually involves both the right
and left sides, giving symptoms and
signs related to both - congestive
cardiac failure. Sometimes left or right
heart failure predominates, for
example RHF in chronic obstructive
airways disease, and acute LVF in
myocardial infarction. In the ensuing
slides we will consider right and left
heart failure separately.

4. CARDIAC FAILURE
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SIDE OF HEART
AFFECTED
LEFT pulmonary congestion and
oedema - breathlessness
RIGHTperipheral oedema
hepatic congestion
raised JVP
CONGESTIVE : R & L
Note: chronic LHF leads to RHF

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CAUSES OF CARDIAC FAILURE
• ischaemic heart disease
• systemic hypertension
• valvular heart disease
• congenital heart disease
• lung disease COAD
(cor pulmonale)
• Rarities e.g. cardiomyopathy

6. CARDIAC FAILURE
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LEFT HEART FAILURE:
EFFECTS
Acute LHF -Pulmonary
oedema
Frothy
blood
stained
sputum
Chronic LHF - Dyspnoea
on exertion
Poor renal perfusion - Renin-
angiotensin
system activated

7. CARDIAC FAILURE
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LEFT HEART FAILURE:
THE RENIN-ALDOSTERONE-
ANGIOTENSIN SYSTEM
Poor renal perfusion is sensed by the
juxtaglomerular apparatus, which secretes
renin. Renin converts angiotensinogen in
the blood to angiotensin1. This in turn is
converted by ACE (angiotensin converting
enzyme) to angiotensin2, which increases
blood pressure directly by
vasoconstriction and by increasing
adrenal secretion of aldosterone. ACE
inhibitors are used to treat heart failure as
well. as hypertension. Diuretic drugs are
another mainstay of treatment.
THE RENIN ANGIOTENSIN ALDOSTERONE SYSTEM
ACE
ACE INHIBITORS
JGA
RENIN
ADRENAL
ALDOSTERONE
ANGIOTENSINOGEN ANGIOTENSIN 1
ANGIOTENSIN 2
VASOCONSTRTICTS
Na RETENTION
INCREASED BP

8. CARDIAC FAILURE
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THE RENIN ANGIOTENSIN ALDOSTERONE SYSTEM
ACE
ACE INHIBITORS
JGA
RENIN
ADRENAL
ALDOSTERONE
ANGIOTENSINOGEN ANGIOTENSIN 1
ANGIOTENSIN 2
VASOCONSTRTICTS
Na RETENTION
INCREASED BP

9. CARDIAC FAILURE
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CARDIAC FAILURE
INTRODUCTION
CAUSES
LEFT HEART FAILURE
RIGHT HEART FAILURE
CONGESTIVE CARDIAC FAILURE
DIAGNOSIS
DYSPNOEA
AGE EFFECTS
HIGH OUTPUT FAILURE

10. CARDIAC FAILURE
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RIGHT HEART FAILURE:
EFFECTS
Hepatic congestion:
nutmeg appearance
Raised JVP
Oedema - Tissues: Ankles
and sacrum
Pleural and
peritoneal
cavities

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RIGHT HEART FAILURE:
EFFECTS 1
Hepatic congestion:
nutmeg appearance
Raised JVP
Oedema - Tissues: Ankles
and sacrum
Pleural and
peritoneal
cavities
The photograph shows the “nutmeg”
liver of chronic venous congestion

12. CARDIAC FAILURE
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RIGHT HEART FAILURE:
EFFECTS 2
Hepatic congestion:
nutmeg appearance
Raised JVP
Oedema - Tissues: Ankles
and sacrum
Pleural and
peritoneal
cavities
The photograph shows pitting oedema of
the ankle. An indentation has been left by
firm digital pressure

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RIGHT HEART FAILURE:
EFFECTS 3
Hepatic congestion:
nutmeg appearance
Raised JVP
Oedema - Tissues: Ankles
and sacrum
Pleural and
peritoneal
cavities
The photograph shows bilateral pleural
effusions.

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PLEURAL EFFUSIONS

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RIGHT HEART FAILURE:
COR PULMONALE
Cor pulmonale is the term
given to heart failure due to
lung disease, such as chronic
obstructive airways disease.

16. CARDIAC FAILURE
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CARDIAC FAILURE
INTRODUCTION
CAUSES
LEFT HEART FAILURE
RIGHT HEART FAILURE
CONGESTIVE CARDIAC FAILURE
DIAGNOSIS
DYSPNOEA
AGE EFFECTS
HIGH OUTPUT FAILURE

17. CARDIAC FAILURE
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CONGESTIVE
CARDIACFAILURE:
EFFECTS
Congestive = Combined R & L
Most cases are congestive but
sometimes features of R or L
CF predominate

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CONGESTIVE
CARDIACFAILURE:
CLINICAL FEATURES
SUMMARY
dyspnoea
oedema
venous congestion
raised JVP
mild hepatomegaly

19. CARDIAC FAILURE
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CARDIAC FAILURE
INTRODUCTION
CAUSES
LEFT HEART FAILURE
RIGHT HEART FAILURE
CONGESTIVE CARDIAC FAILURE
DIAGNOSIS
DYSPNOEA
AGE EFFECTS
HIGH OUTPUT FAILURE

20. CARDIAC FAILURE
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CARDIAC FAILURE
DIAGNOSIS
•History
•Examination
• Chest X-RAY
• ECG
•Echocardiography
•BNP
BNP =
B type natriuretic peptide.
Hormone released into
plasma by steressed
myocytes in CF

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CARDIAC FAILURE
INTRODUCTION
CAUSES
LEFT HEART FAILURE
RIGHT HEART FAILURE
CONGESTIVE CARDIAC FAILURE
DIAGNOSIS
DYSPNOEA
AGE EFFECTS
HIGH OUTPUT FAILURE

22. CARDIAC FAILURE
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DYSPNOEA
Dyspnoea (breathlessness) occurs in
left heart failure. At first the
pulmonary vascular beds become
congested.
Later fluid builds up in the interstitium
(the space between capillary
endothelial cells and alveolar lining
cells), and this is known as
interstitial oedema.
Finally fluid enters the alveoli giving
pulmonary oedema as shown in the
radiograph.

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PULMONARY OEDEMA

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In the early stages of pulmonary
oedema, crepitations (fine
crackles) are heard on
auscultation.
In severe pulmonary oedema
frothy sputum can be produced.
Occaisionally this can be
bloodstreaked, for example in
pulmonary oedema due to mitral
stenosis.
DYSPNOEA

25. CARDIAC FAILURE
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On lying down dependent vascular
and extravascular fluid
enters the central circulation.
In heart failure the heart cannot
cope with the increase load and
pulmonary congestion and
oedema result
DYSPNOEA:
SPECIAL TYPES

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The two clinical syndromes
associated with this are:
Orthopnoea: dyspnoea on lying
down flat.
Paroxysmal nocturnal
dyspnoea: intermittent attacks of
dyspnoea while in bed. The
patient typically goes to an open
window gasping for breath and
waits for recovery.
DYSPNOEA:
SPECIAL TYPES

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CARDIAC FAILURE
INTRODUCTION
CAUSES
LEFT HEART FAILURE
RIGHT HEART FAILURE
CONGESTIVE CARDIAC FAILURE
DIAGNOSIS
DYSPNOEA
AGE EFFECTS
HIGH OUTPUT FAILURE

28. CARDIAC FAILURE
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CARDIAC FAILURE:
AGE DIFFERENCES
Babies and old people sometimes
do not give classical symptoms
and signs of heart failure.
Babies typically show rapid
breathing (tachypnoea), rapid
heartbeat (tachycardia) and poor
feeding.
Old people can simply be lethargic
with nausea and vomiting.

29. CARDIAC FAILURE
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CARDIAC FAILURE
INTRODUCTION
CAUSES
LEFT HEART FAILURE
RIGHT HEART FAILURE
CONGESTIVE CARDIAC FAILURE
DIAGNOSIS
DYSPNOEA
AGE EFFECTS
HIGH OUTPUT FAILURE

30. CARDIAC FAILURE
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CARDIAC FAILURE: HIGH OUTPUT FAILURE
In most cases of heart
failure the cardiac output
is low. In rare situations,
there may be no intrinsic
heart disease, but the
heart is put under such a
high load that it cannot
cope and eventually fails.
This is known as high
output failure.
Examples of this include
very severe anaemia and
hyperthyroidism.
Massively enlarged thyroid gland in
hyperthyroidism.

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Return to Cardiovascular
Pathology Index Page
END OF PRESENTATION