pathophysiology of congestive heart failure #simple to learn

pathophysiology of congestive heart failure

What is heart failure?

It doesn’t mean to a sudden stop the heart working. It means heart does not enough blood flow in the body.  Heart failure means “not a proper circulation of blood in the body via heart. It’s a very complicated disease. 

Various symptoms of heart failure include ventricular emptying, shortness of breath, fatigue, ankle sweating and etc. It mostly affects in the left ventricles of the heart.

These main two condition leads to heart failure.
➔ Low blood output
➔ High blood output

In low blood output, heart flows less amount of blood in the body due to myocardial infarction, myocardial ischemic, and cardiomyopathy.

In high blood output, the heart flows more amount of blood in the body. Its elevated blood flows because of anemia (oxygen-carrying capacity decrease) and hyperthyroidism. 

If an increase the cardiac output doesn’t mean requirement of metabolism is increased. That’s why it leads to heart failure.

In this article I will share everything about the pathophysiology of congestive heart failure. So, stay tuned with us.




    Pathophysiology of congestive heart failure

    First of all understand a congestive heart failure pathophysiology, understand a common information and types of congestive heart failure.

    Definition of congestive heart failure

    Simple definition of CHF is “unable to enough blood flow that needs to body or cardiac output” Weakness of Heart muscle (myocardium) leads to a decrease in blood flow in the body. Not enough blood flow through the heart.

    Decrease a nutrient and oxygen level in body because of not the proper manner of blood flow in the body. That’s why weakness produces in the body. Sometimes, the heart does not pump the blood leads to the accumulation of blood in the heart that toxic and very dangerous to our body.

    Different types of congestive heart failure

    Systolic heart failure,
    Diastolic heart failure,
    Left-sided heart failure,
    Right-sided heart failure,

    Most common heart failure is systolic and diastolic heart failure.

    ➔ In systolic heart failure, ventricle of the heart decreases its myocardial (heart muscle) contractility. It's not able to generate enough blood flow.

    It decreases stroke volume leads to a decrease in cardiac output. It also decreases ejection fraction. (here, you learn stroke volume and cardiac output relation cardiac output

    Symptoms of systolic heart failure is hypertension and coronary artery disease.

    ➔ In diastolic heart failure, to decrease preload of ventricles. 20 to 40% heart failure due to systolic heart failure.

    Abnormal left ventricle function. But, decrease a filling of the left ventricle leads to impaired ventricle relaxation. Heart muscle actually to stiffed due to diastolic heart failure. Symptoms of diastolic failure, include fatigue, congestion, and dyspnea.

    ➔ In Left sided heart failure, left part of the heart are responsible to provide oxygenated blood body tissue from heart.

    To fluid accumulate in the left side of the lungs that causes shortness of breath. It refers to congestive heart failure due to pulmonary edema (pulmonary congestion).

    Left-side heart failure → increase left ventricle preload and increase left ventricle end-diastolic volume  decrease left ventricle cardiac output  pulmonary edema ( fluid accumulation in heart)

    ➔ In Right sided heart failure, increase pulmonary pressure on right part of heart.
    To fluid accumulate in abdominal, legs, feet leads to peripheral edema (fluid accumulation in another part of body)

    To increase a cardiac workload on the right ventricle leads to dilation of right-sided heart. Due to right-sided heart failure leads to some other disease include COPD, cystic fibrosis  and adult respiratory distress syndrome (accumulation of fluid in lungs sac)

    Right-sided heart failure  increase pulmonary vascular resistance  increase right ventricle preload and right ventricle oxygen demand  peripheral edema (accumulation of fluid in other parts of the body)

    What is Pathophysiology of congestive heart failure?

    pathophysiology of congestive heart failure
    pathophysiology for congestive heart failure 

    Heart failure leads to reduce the elasticity of the heart muscle (myocardium).

    It is caused by the various condition following

    ➔ Myocardial infraction (heart blood flow abruptly)
    ➔ Myocardial ischemic (blood flow of heart reduced)
    ➔ Hypertension (elevate blood pressure)
    ➔ Coronary artery disease (plaque in an artery)

    if you learn heart arrhythmia medication visit this article arrhythmia medication

    In the pathophysiology of congestive heart failure, mainly this all condition is decreasing cardiac output. (also decrease stroke volume of the heart)

    If cardiac output decrease the requirement of blood in the body is an imbalance (doesn’t meet the body requirement) and it affects on heart function.

    Due to reduce stroke volume leads to failure of systole and diastole of the heart.

    Reduce heart contractility leads to increase end-diastolic volume.

    Accumulation of blood in the ventricle leads to decrease heart muscle contraction.

    In congestive heart failure contribute to “exercise intolerance” due to heart not take too much load in this condition.

    It also a works very harder to meet body’s metabolic needs include oxygen, minerals and etc.
    Due maintain its cardiac output activity, heart rate increase. But, blood filling time of heart is also decreases leads to less blood flow.

    Hypertrophy (increase size) is an increase stiffness of ventricle leads to decrease relaxation capacity of the ventricle.

    That enlargement of the ventricle leads to decrease cardiac output because contraction of the ventricle is impaired.

    But, Heart is attempt some structural changes to increase its stroke volume and cardiac output. in this situation, the heart produces two types of conditions. (as per images)

    Condition 1 = Dilated cardiomyopathy
    Condition 2 = hypertrophy cardiomyopathy

    In dilated cardiomyopathy, ventricle walls are thin and ventricle are enlarged but it's weaker. And that’s why its losse leverage.

    In hypertrophy cardiomyopathy, ventricle walls are thick but ventricle are stiffer leads to less blood filling in ventricles.

    to decrease cardiac output, “blood flow in kidney” is also reduced. To reduce blood flow that leads to increase renin from the kidney. Renin leads to the production of angiotensinogen from plasma. That following converted to angiotensin 1 and 2 (as per image). Also, release aldosterone from the adrenal gland.

    Angiotensin, are a powerful vasoconstrictor, it increases systemic blood pressure on the kidney tubules. That also elevate blood pressure and lead to congestive heart failure.

    Aldosterone, aldosterone is released from the adrenal gland. It acts on kidney tubules to increase retention of salt and water. (fluid accumulation) that also increases blood pressure.

    What is signs and symptoms of congestive heart failure?

    ➝ Chest pain
    ➝ Wheezing, coughing and Shortness of breath
    ➝ Crackers in the lungs
    ➝ Jugular vein distention
    ➝ Weakness and fatigue
    ➝ Abnormal heart sounds or irregular heartbeat
    ➝ Inflammation in ankles
    ➝ Rapid weight gain from fluid retention
    ➝ Urinated Frequency increase

    congestive heart failure diagnosis

    if upper symptoms are present in your body, your consultant or doctor conduct several type of tests to diagnose heart failure.

    X-ray. (radiography) in X-ray electromagnetic waves are aligns on your body and take images of your particular body part. Your consultant has seen your actual heart condition through images and also details understand your sign and symptoms.

    ECG. (electrocardiogram) it records to electrical activity of your heart and also checks the heart’s rhythm. Your consultant Analyse your ECG report and check sign and symptoms of congestive heart failure.

    CT scan. (computerized tomography) it takes images of your insider body part used with a doughnut-shaped machine. It has taken each and every part of the heart. So, these types of images provide more details then X-ray.

    Biopsy. (myocardial)  using a biopsy cord your consultant takes a small part of your heart muscle (myocardium) to examine your heart muscle disease and various complications.

    MRI. (magnetic resonance imaging)  using strong radiation and magnetic particle takes images of the organ part. magnetic particle is aligned on your organ and take images of your organ. Your consultant is details examine your heart condition via MRI.

    Blood test. Your consultant takes your blood and perform a various test to examine blood and find out various symptoms that affect of your heart.   

    also, various diagnosis test is performed include a stress test, angiogram and etc.

    Treatment of congestive heart failure

    treatment of congestive heart failure is directly based on the pathophysiology of congestive heart failure and its mechanism include preload, afterload, workload, kidney disturbance etc. here, I will discuss one by one treatment and medication of congestive heart failure.

    ➣ Vasodilators drugs. Vasodilator drugs are dilated peripheral arteries and veins. It relaxes the vascular smooth muscle. Also, reduce preload and afterload of the heart. It dilates peripheral arteries by the blockage of an alpha adrenoreceptor, to decrease afterload of heart.
    Prazosin is the most common arterial vasodilator drug in the market.

    ➣ Diuretics drugs. Diuretics are actively decreasing sodium and potassium reabsorption. And increase urine output. Whenever reabsorption is decreased excretion of fluid is also increasing. It also reduced accumulate fluid and salt in the body. And monitor for hypotension.

    Fluid and salt restriction. Furosemide is used to reduced body fluid. It is a powerful diuretic. Mostly furosemide is used to reduced body fluid.

    Example of diuretics,

    Thiazide diuretics.
    ⇨ Hydrochlorothiazide (hydrodiuril)
    ⇨ Chlorothiazide (diuril)
    ⇨ Chlorthalidone (hygroton)
    ⇨ Indapamide (lozol)
    ⇨ Metolazone (zaroxolyn)

    Loop diuretics.
    ⇨ Bumetanide (bumex)
    ⇨ Furosemide (Lasix)
    ⇨ Torsemide (Demadex)

    Potassium-sparing diuretics.
    ⇨ Amiloride (Midamor)
    ⇨ Spironolactone (Aldactone)
    ⇨ Triamterene (dyrenium)
    ⇨ Eplerenone (aldoctone)

    ➣ ACE inhibitors drugs. It blocks the formation of angiotensin and aldosterone.

    ACE inhibitors are open narrowed vessels to increase its blood flow. and improve cardiac output. ACE inhibitors also reduce vascular resistance (afterload) which leads to restricting fluid retention.

    Example of ACE inhibitors,

    ⇨ Captopril (Vasotec)
    ⇨ Lisinopril (Zestril)
    ⇨ Fosinopril (Monopril)
    ⇨ Moexipril (Univasc)
    ⇨ Perindopril (Aceon)
    ⇨ Quinapril (Accupril)
    ⇨ Rimipril (Altace)
    ⇨ Trandolapril (Mavik)

    ➣ Beta-blocker. Beta-blocker is reduced blood pressure. It also decreases arrhythmia and cures myocardial infarction and myocardial ischemia.

    Example of beta-blockers,

    ⇨ Acebutolol (Sectral)
    ⇨ Bisoprolol (Zebeta)
    ⇨ Atenolol (Tenormin)
    ⇨ Metoprolol (Lopressor)
    ⇨ Esmolol (Brevibloc)
    ⇨ Nadolol (Corgard)

    ➣ Cardiac inotropic drugs. positive ionotropic drugs are pumping more blood within fewer heartbeats. This medicine is also given in a sudden heart attack.

    It increases the force of contraction by the increased intracellular calcium in the cardiac muscle cell.

    ⇨ Example of cardiac glycoside. Digoxin, Digitalis, Dobutamine.

    ⇨ Example of phosphodiesterase inhibitors. Milrinone, Amrinone.

    ➣ Heart failure devices. Include heart transplantation, valve replacement, angioplasty, coronary bypass, left ventricle assist device and etc. (if you learn the latest heart devices, visit this article latest heart devices




    Conclusion: in this article, I discussed congestive heart failure pathophysiology, its symptoms, diagnosis, and treatment. if you like, comment out.