Left heart failure

Left heart failure

1. LEFT HEART FAILURE

2. MECHANISM

3. HOW DOES THE PATIENT PRESENTS WITH? DYSPNOEA -INITIALLY EXERTIONAL THEN PROGRESSING TO DYSPNOEA AT REST GRADE I → GRADE IV MECH :

4. ↓PULM.COMPLIANCE ↑ AIRWAY RESISTANCE RESPIRATORY MUSCLE &DIAPHRAGM FATIGUE

5. 2 . ORTHOPNOEA DYSPNOEA OCCURING IN RECUMBENT POSITION RELIEVED BY SITTING UPRIGHT OR SLEEPING ON ADDITIONAL PILLOWS NOCTURNAL COUGH MAY BE PRESENT MECH:-REDISTRIBUTION OF FLUID FROM SPLANCHNIC CIRCULATION &LOWER EXTREMITIES IN TO CENTRAL CIRCULATION→ INCREASE IN PULM. CAPILLARY PRESSURE - ELEVATION OF DIAPHRAGM

6. 3.PAROXYSMAL NOCTURNAL DYSPNOEA A/C EPISODES OF DYSPNOEA &COUGHING OCCURING AT NIGHT WHICH AWAKEN THE PATIENT FROM BED 1-3 HRS AFTER HE RETIRES PERSISTS EVEN AFTER SITTING UPRIGHT MECH:-DEPRESSION OF RESP. CENTRE DURING SLEEP -REDUCED ADRENERGIC STIMULATION OF MYOCARDIUM AT NIGHT

7. 4.CARDIAC ASTHMA PULM.EDEMA &BRONCHIAL WALL EDEMA ↓ WHEEZING 5.A/C PULM. EDEMA -MARKED ELEVATION OF PULM. CAPILLARY PRESS. ↓ ALVEOLAR EDEMA ↓ COUGH WITH COPIOUS PINKISH FROTHY SPUTUM &BILATERAL CREPITATION

8. 6.CHEYNE STOKES RESPIRATION PERIODIC BREATHING WITH ALTERNATE PERIODS OF APNOEA & HYPERVENTILATION MECH:-DIMINISHED SENSITIVITY OF RESP. CENTRE TO ARTERIAL PCO2 7 .CENTRAL & PERIFERAL CYANOSIS 8.FATIGUE 9.MENTAL CONFUSION

9. 3. CARDINAL SIGNS OF LVF GALLOP RHYTHM S1+S2+S3 OR S1+S2+S4----TRIPLE RHYTHM S1+S2+S3+S4-----QUADRUPLE RHYTHM IF S3 &S4 MERGE ----SUMMATION GALLOP FINE BASAL CREPITATIONS PULSUS ALTERANS —WHEN THE ALTERNATE PULSES ARE WEAK.[LOW VOL.] BUT RHYTHM IS NORMAL -BETTER FELT IN RADIAL A -HEALTHY &DEGENERATED MUSCLE FIBRES PRODUCING NORMAL &WEAK BEAT RESPECTIVELY[DEFECTIVE ELECTROMECHANICAL COUPLING] -POOR PROGNOSIS

10. BP: ↓PULSE PRESSURE DUE TO REDUCED STROKE VOL. HYPOTENTION DBP SLIGHTLY RAISED IF CARDIOMEGALY –APEX SHIFTED OUTWARDS & DOWNWARDS

11. CHEST X–RAY FINDINGS PROMINANT UPPER LOBE VEINS KERLEY B LINES – HORIZONTAL LINES IN COSTOPHRENIC ANGLES- THICKENED INTERLOBULAR SEPTA & ENGORGED PERIPHERAL LYMPHATICS IN LOWER LOBE BAT’S WING -INCREASED BRONCHOVASCULAR MARKINGS[INVERTED MOUSTACHE SIGN] CARDIOMEGALY PLEURAL EFFUSION