Chapter IV

                                       Pathophysiology of Congestive Heart Failure



                                                                                   Precipitating:
                          Predisposing:
                                                                              Hypertension
                                                                              tobacco and alcohol use
                        Gender (male)
                                                                              sedentary lifestyle
                        Age (56 yrs. old)
                                                                              food intake of “bulad” or
                                                                              dried fish, fried fish, soy
                                                                              sauce, noodles, “”adobong
                                                                              manok or baboy”, “ginamos”




                                                     Cardiac Insult


                                             Increase workload of the right        LEGEND:
                                                       ventricle
                                                                                           -   Factors

                                                Myocardial dysfunction                     -   Signs and symptoms


(continuation at the next page)               Damage in pumping capacity
                                                                                           -   Laboratory results
                                                    of the heart
C
                                                                                                                                  O
              ↓ Renal tissue perfusion                                  ↓ cardiac output                       ↓ systemic blood
                                                                                                                   pressure       M
                                                                                                                                  P

                                            Release of renin                                                                      E
 Ischemia
                                             by the kidney                                 Sensed by Baroreceptors in             N
                                                                                           the:
                                                                                             Aortic                               S
Easy fatigability                                                                            Carotid bodies
                                                                                                                                  A
                                                                                                                                  T
                                                                                           Sympathetic Nervous system
                                                                                               will be stimulated                 O
                                         Releases Angiotensin I
              Gives signal to the             in the liver                                                                        R
                Hypothalamus
                                                                                                catecholamines                    Y
                                                                                                Epinephrine
                                                                                                Norepinephrine
              Release of ADH                                                                                                      M
          (antidiuretic hormone)
                                                                                                Vasoconstriction                  E
                                         Conversion of Angiotensin I (weak
                                         vasoconstrictor) to Angiotensin II                                                       C
          ↓ Urine output                 (potential vasoconstrictor) in the
          [Helps reabsorb the fluid      lungs by ACE (Angiotensin                                BP                              H
          back into the blood which      Converting Enzyme)                                       blood volume                    A
          preserves blood volume
          so that it will not decrease                                                                                            N
          further]
          (Please refer to the               aldosterone                                                                          I
          appendix A )                     (Release by the
                                           adrenal cortex)                                                                        S
                                                                                                                                  M
Na and ↓ K


                                   water
                                 reabsorption      Fluid Volume Overload




    Change in                                                                                            preload and
 hydration status                                                               ↓ cardiac                afterload
                                                                                 output
                     Dec. 17,2012:
↓ albumin in                                                                                           Stress on the
                     Albumin- 26.72 g/L                                     Regurgitation
vascular system                                             murmur                                      ventricular
                     (normal range- 34-                                     (backflow)
                     50 g/L)                                                                          walls and valves

  hydrostatic
  pressure                                                                                                workload of
                                                           Ventricular       Heart tries to
                                                          hypertrophy        compensate                   the heart
                     Dec. 11, 2012:
↓ sodium in the
                     Sodium (Na)- 131.50
vascular system                                                                     Overdistended cardiac chambers
                     (normal value- 135.7              Results in
                                                                                    release:
                     – 145 mmol/L)                     myocardial cells,
                                                                                      ANP (atrial natriuretic peptide)
  sodium in the                                        ” ventricular                  BNP (brain natriuretic peptide)
interstitial space                                     remodeling”


Water follows                                        Mild cardiomegaly
                                                     (please refer to the         Not strong enough to overcome the
                                                     ultrasound result)              negative effects of the other
edema                                                                                         mechanism

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  • 1. Chapter IV Pathophysiology of Congestive Heart Failure Precipitating: Predisposing: Hypertension tobacco and alcohol use Gender (male) sedentary lifestyle Age (56 yrs. old) food intake of “bulad” or dried fish, fried fish, soy sauce, noodles, “”adobong manok or baboy”, “ginamos” Cardiac Insult Increase workload of the right LEGEND: ventricle - Factors Myocardial dysfunction - Signs and symptoms (continuation at the next page) Damage in pumping capacity - Laboratory results of the heart
  • 2. C O ↓ Renal tissue perfusion ↓ cardiac output ↓ systemic blood pressure M P Release of renin E Ischemia by the kidney Sensed by Baroreceptors in N the: Aortic S Easy fatigability Carotid bodies A T Sympathetic Nervous system will be stimulated O Releases Angiotensin I Gives signal to the in the liver R Hypothalamus catecholamines Y Epinephrine Norepinephrine Release of ADH M (antidiuretic hormone) Vasoconstriction E Conversion of Angiotensin I (weak vasoconstrictor) to Angiotensin II C ↓ Urine output (potential vasoconstrictor) in the [Helps reabsorb the fluid lungs by ACE (Angiotensin BP H back into the blood which Converting Enzyme) blood volume A preserves blood volume so that it will not decrease N further] (Please refer to the aldosterone I appendix A ) (Release by the adrenal cortex) S M
  • 3. Na and ↓ K water reabsorption Fluid Volume Overload Change in preload and hydration status ↓ cardiac afterload output Dec. 17,2012: ↓ albumin in Stress on the Albumin- 26.72 g/L Regurgitation vascular system murmur ventricular (normal range- 34- (backflow) 50 g/L) walls and valves hydrostatic pressure workload of Ventricular Heart tries to hypertrophy compensate the heart Dec. 11, 2012: ↓ sodium in the Sodium (Na)- 131.50 vascular system Overdistended cardiac chambers (normal value- 135.7 Results in release: – 145 mmol/L) myocardial cells, ANP (atrial natriuretic peptide) sodium in the ” ventricular BNP (brain natriuretic peptide) interstitial space remodeling” Water follows Mild cardiomegaly (please refer to the Not strong enough to overcome the ultrasound result) negative effects of the other edema mechanism