2 hyperemia-congestion

for Undergraduate medical students (MBBS)

1. HemodynamicsHemodynamics
Hyperemia and CongestionHyperemia and Congestion
Dr.CSBR.Prasad, M.D.

2. Hyperemia and Congestion Hyperemia and Congestion
Both are vascular events

4. Hyperemia and Congestion Hyperemia and Congestion
•Both indicate a local increased volume of
blood in a particular tissue.
•There is increased vascular volume
•Hyperemia is an active process - arteriolar
dilation – arterial side
•Congestion is a passive process -
impaired outflow – venous side - may be
systemic / local

5. HyperemiaHyperemia CongestionCongestion
Blood volume
Increased Increased
Vascular
volume
Increased Increased
Mechanism Active –
chemicals
Passive –
stagnation
Vascular
compartment
Arterial sideVenous side
Site
Usually localLocal / systemic

7. Hydrostatic pressure is increased in both
the conditions, hence
Hyperemia and congestion are always
associated with edema
Hyperemia and CongestionHyperemia and Congestion

8. Conjunctival hyperemia

9. •Inflammations – conjunctivitis
•Hypercalcemia
•Hyperparathyroidism
•Ataxia – telangiectasia (if the
vessels are tortuous)
Conjunctival hyperemia - causesConjunctival hyperemia - causes

10. Sturge-Weber SyndromeSturge-Weber Syndrome
Blanching (circle)Blanching (circle)

11. CongestionCongestion
•Distension of blood vessels
•May be an active or passive process
•Reversible condition

13. Left-sided cardiac failure
Causes:
•1. Systemic hypertension (most common
cause).
•2. Ischemic heart disease.
•3. Mitral or aortic valve disease.
•4. Primary myocardial disease.

14. Left-sided cardiac failure
Clinical presentation
1. Due to obstruction to pulmonary vascular out-flow there
is pulmonary congestion and edema.
2. Reduction of renal perfusion causes:
(i) Salt and water retention (ii) Ischemic acute tubular
necrosis
(iii) Impairment of waste excretion causing azotemia.
3. Reduced perfusion of central nervous system causes
hypoxic encephalopathy (irritability to coma).

15. Right-sided cardiac failure
Causes:
1. Most common cause is the left ventricular failure, causing pulmonary congestion and
raised pulmonary arterial pressure.
2. Intrinsic disease of lungs and pulmonary vasculature causing obstruction to right
ventricular out-flow (cor pulmonale).
3. Pulmonary or tricuspid valve disease.
4. Congenital heart disease in which there is left-to-right shunt.
Example: (i) Patent foramen ovale ; (ii) Patent ductus arterisus and (iii) Interventricular
septal defect.
Other causes:
i) Extracardiac circulatory failure. Example: Haemorrhage ; vasovagal syncope etc.
ii) Impaired atrial filling by external compression. Example: Constrictive pericarditis.

16. Right-sided cardiac failure
Clinical presentation
1.Congestion and edema of portal and dependent
peripheral sites
(Eg: feet, ankle, sacrum) and effusions in pleura and
peritoneum (ascites).
2. Hepatomagaly - Centrilobular congestion and atrophy of
central hepatocytes (nutmeg liver)
3. Congestive splenomegaly with sinusoidal dilation, focal
hemorrhage followed by hemosiderosis and fibrosis.
4. Renal congestion causes acute hypoxic tubular necrosis.

17. Normal liverNormal liver

18. Normal liverNormal liver

19. CVC liver -- GrossCVC liver -- Gross
In chronic passive congestion of the liver
(nutmeg liver)
the central regions of the hepatic lobules are
grossly red-brown and slightly depressed
(owing to a loss of cells) and are
accentuated against the surrounding
zones of uncongested tan liver (nutmeg
liver)

20. CVC – LiverCVC – Liver
‘Starry sky’
appearance
in US

21. Nut meg liver

22. Nut megNut meg

23. •Centrilobular necrosis with loss of
hepatocytes dropout and
•Hemorrhage, including hemosiderin-laden
macrophages
•Hepatic fibrosis [In severe, long-standing
hepatic congestion there may even be
grossly evident hepatic fibrosis (cardiac
cirrhosis)]
CVC liver -- microscopyCVC liver -- microscopy

24. In acute hepatic congestion:
•Central vein and sinusoids are distended
with blood
•Central hepatocyte degeneration
•The periportal hepatocytes - may only
develop fatty change.
CVC liver -- MicroscopyCVC liver -- Microscopy

28. CVC - Liver

29. Centrilobular necrosis - causesCentrilobular necrosis - causes
NOTE: Because the central portion of the
hepatic lobule is the last to receive blood,
centrilobular necrosis can also occur
whenever there is reduced hepatic blood
flow (including shock from any cause);
there need not be previous hepatic
congestion.

30. CVC LungCVC Lung

33. Pulmonary
edema

34. •The cut surfaces of hyperemic
•tissues are hemorrhagic and wet
CVC Lung - GrossCVC Lung - Gross

35. Acute pulmonary congestion:

•alveolar capillaries engorged with
blood
•alveolar septal edema and/or
•focal intraalveolar hemorrhage
CVC Lung - CVC Lung - Microscopic

36. Chronic pulmonary congestion:
•the septa are thickened and fibrotic
•the alveolar spaces may contain
numerous hemosiderin-laden
macrophages (heart failure cells).
CVC Lung - CVC Lung - Microscopic

37. Pulmonary edema with a few extravasated RBCs

38. Heart failure cells

39. CVC – Lung [ Perl’s stain ]

40. E N DE N D
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