Pathophysiology of

CHF

CHF
What is CHF?
Fix the underlying problem
Heart is a 2 sided pump
Both sides can fail independent of each
other.

CHF
What different types of pathophysiology
cause it?
Systolic Dysfunction
Diastolic Dysfunction
High Output States

CHF
Systolic Dysfunction What is it? Is it only related to
events that occur in Systole?
-1. Decreased Contractility
- a. Loss of Myocytes
- b. Over-stretched Heart
-2. Increased Afterload
- a. Increased BP
- b. Stenotic Valve
- Pulmonic Valve and carcinoid
syndrome 5HIAA

CHF
Diastolic Dysfunction What is it?
1. Impaired Relaxation
2. Obstruction to filling

Can systolic and diastolic functions

coexist?

CHF
Pressure volume loops are used to distinguish between
systolic vs. diastolic dysfunction

CHF
High Output States What is it?
Pagets Disease
Anemia
Thiamine Deficiency
Hyperthyroidism

CHF
The failing heart and how it compensates
What does a failing heart mean, and what is
decompensation? What does a failing heart
look like?
Compensations made by a failing heart
Frank Starling Forces
Neuro-Hormonal Changes
Ventricular Remodeling

CHF
What is looks like:

CHF Compensations
Frank Starling
Length Tension Mechanism

CHF Compensations
L sided failure and Frank
Blood is not going to go forward
Blood is going to back up into L atrium and
pulmonary venous circulation
L Atrium, what happens when it distends?

CHF Compensations
Hoarseness:

CHF Compensations
L sided Failure and Frank
Blood eventually backs up into the pulmonary
circulation
What happens there?

Whats the deal with Frank Starling Forces?

CHF Compensation
L sided failure and the lungs continued
Pulmonary congestion

CHF Compensation
L sided failure and lungs continued
Pulmonary Hypertension
Does pulmonary hypertension happen
immediately?

L sided Compensation
L sided failure and CXR
Cephalization
Indistinct vessels, Kerly B-Lines
Whited Out lungs fields

CHF Compensations
L sided failure symptoms related to congestion
Blood not going forward:
Muscle fatigue
Confusion

Blood going backwards:

Atrial Distension

Arrhythmias
Thrombus formation
Hoarseness
Mitral Regurgitation
S3

CHF Compensations
L sided failure symptoms continued
Blood going backwards continued
Pulmonary congestion

Pulmonary edema
Pulmonary hypertension R sided failure
Dyspnea, Dyspnea at night
Nocturnal enuresis
Orthopnea
Cardiac Asthma
Hypoxia, cyanosis

CHF Compensations
R sided failure and Frank:

Most Common Cause is?

Cor pulmonale?
Blood is going to eventually back up into the R atrium and systemic and portal venous
circulation.

CHF Compensations
What happens when this blood backs up?
Liver Congestion

Gastrointestinal Tract

Nutmeg Liver

CHF Compensations
What happens when this blood backs up
continued
Pitting Edema
Frank Starling Forces

Stasis Dermatitis

P02?

CHF Compensations
JVD jugular venous pressure chart

CHF Compensations
Acute R sided failure
Causes?
Would you expect to see any change to the R
ventricle?

CHF Compensations
R sided failure symptoms from the backing
up of blood:
Pitting Edema
JVD
GI discomfort
Liver congestion
RUQ pain
Hepatojugular Reflex
Ascites Puddle sign

CHF complications
Would you expect someone with R sided
failure only, that is, no L sided failure, to
have pulmonary hypertension or
pulmonary edema?

CHF Compensations
Neurohormonal changes:
Renin-Angiotensin System
Adrenergic System
ADH

CHF Compensations
Renin-Angiotensin System raise EABV,
and lower plasma oncotic p.

CHF Compensations
Does the Renin-Angiotensin System
restore EABV back to normal?
Why is this harmful in the end?

CHF Compensations
Adrenergic System:
Increased Sympathetic
outflow
Increased effects of
epinephrine on adrenergic
receptors throughout your
body
What pathological process
could keep the adrenergic
system on even if the
EABV is restored?

CHF Compensations
Does the adrenergic system restore the
EABV?

Why is this harmful in the end?

CHF Compensations
ADH secretion
Why do its effects become blunted in long
run?

CHF Compensations
Ventricular Remodeling