What is the difference between heart failure and backward heart failure?
Forward failure impairs movement of blood into the vessels emerging from the heart
Backward failure allows blood to accumulate in the vessels or heart chambers located behind the failing ventricles and results in congestion of the pulmonary and venous system circulation
What is the difference between the causes of left heart failure and right heart failure?
Left - ischemic heart disease, HTN, aortic and mitral valve disease, and non-ischemic myocardial disease (myocarditis)
Morphologic and clinical effects primarily results from progressive damming of blood w/in the pulmonary circulation and the consequences of diminished peripheral blood flow
Right - Secondary consequence of left heart failure b/c any ↑ in pressure in the pulmonary circulation incident to left heart failure produces an ↑ burden on the right side; therefore, the causes of right heart failure must include all those that induce left heart failure
RHF causes congestion of the peripheral organs and extremities
What are the features of the heart and the lungs in left-sided CHF?
Left ventricle - hypertrophied w/ massive chamber dilation
Then secondary enlargement of the left atrium
Enlargement may cause A. Fib. w/ blood stasis and possible thrombus formation w/ the change of emboli
Lungs - ↑ pressure in the pulmonary veins is transmitted retrograde to the capillaries and arteries, resulting in pulmonary congestion and edema w/ heavy, wet lungs
Edematous widening of the alveolar septae and accumulation of edematous fluid in the alveolar spaces
What are "Heart Failure Cells" in left sided CHF?
Iron-containing hemoglobin from erythrocytes leak from the congested capillaries into the alveoli, the RBC's are phagocytized by alveolar macrophages and are converted to hemosiderin w/in the edematous fluid
What are the clinical features of left-sided CHF?
Accumulated fluid causes cough, fatigue, limb weakness, and dyspnea (breathlessness) on exertion, along w/ orthopnea which is dyspnea on lying down, relieved by sitting or standing
What are the kidneys like in CHF?
↓ CO causes a reduction in renal perfusion, activating RAS, inducing retention of salt and water, expanding the blood volume, which contributes to the pulmonary edema
What is the brain like in CHF?
Far-advanced CHF, the cerebral hypoxia may give rise to hypoxic encephalopathy w/ stupor, loss of consciousness, restlessness, and possible coma
What is the #1 reason for right-sided CHF?
Left Heart Failure
What is Nut-Meg Liver?
Liver increased in size and weight, and a cut section displays chronic passive congestion grossly w/ congestion around the central veins histologically
W/ longstanding CHF, there may be centrilobular necrosis w/ sinusoidal congestion
Liver can become engorged, and function may be impaired and later liver cells may die
What is the liver pathology in right-sided CHF?
Elevated pressure in the portal veins and tributaries
Congestion produces a tense, enlarged spleen (congestive splenomegaly) w/ a weight up to 600 grams
Pressure in the abdominal veins may lead to the accumulation of fluid w/in the abdomen (ascites)
Marked congestion leading to a greater fluid retention and peripheral edema
What are the clinical features of right-sided CHF?
Peripheral Edema - more in lower extremities and in area over the sacrum
Prominent ankle (pedal) and pretibial edema
External jugular vein becomes distended, visualized as JVD
Pleural effusions (>1 liter) may appear and can cause a partial atelectasis
Congestion of the gut may cause anorexia, pain, and weight loss