Heart Failure Manifestations & Causes General Pathology Circulation Disorders - I Heart Failure Manifestations & Causes Jaroslava Dušková Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague
Manifestations of Circulatory Failure in the heart outside heart
Manifestations of Circulatory Failure in the heart acute failure - dilation chronic insuficiency - hypertrophy concentric, excentric outside heart
Manifestations of Circulatory Failure outside heart Acute capilarovenous congestion acute venostasis cyanosis (5g% of red. hemoglobin!) cardial hydrops edema Chronic cyanotic induration (spleen, liver, kidney) red induration (lung) venostatic catarrh vessels hypertrophy cardial hydrops edema
Cardiac Failure venous pressure capillary pressure cardiac output arterial volume ADH renin Na & H2O retention plasma volume transudation EDEMA
Hypertrophic Heart mechanic and paracrine stimuli changed geometry concentric & excentric hypertrophy decreased capillary myocytes ratio myocytes & interstitial tissue composition changes fetal proteins synthesis – beta myosin early genes induction c-myc, c-fos, c-jun decreased beta- adrenergic receptors increased oxygen consumption HEART FAILURE
Causes of Circulatory Failure (1) in the heart endocardium (malformations, fibroelastosis) myocardium (cardiomyopaties,inflammations, hypoxia, tumor, trauma) pericardium (inflammations, synechiae, tumors, hemopericardium) neurological reflex (syncopa) in pulmonary circulation in body circulation (cont.)
Causes of Circulatory Failure (1) in the heart endocardium myocardium pericardium neurological reflex (syncope) pressure changes in pulmonary circulation in body circulation hypertension hypotension – shock, collapse
Cardiomyopathy Def.: specific (non ischaemic, non inflammatory) heart muscle disease leading to heart failure hypertrophic (obstructive) dilated (congestive) restrictive (obliterative)
Causes of Circulatory Failure (2) in pulmonary circulation acute pulmonary hypertension (pneumonia, pleuritis, embolism) chronic pulmonary hypertension (emphysema, fibrotising processses) COR PULMONALE acutum seu chronicum in body circulation (cont.)
Causes of Circulatory Failure (3) in body circulation hypertension „essencial“ renal endocrine COR HYPERTONICUM COR BILATERALE changed blood composition (cont.)
Causes of Circulatory Failure (4) changed blood composition anaemia plethora oligemia hyperphydremia anhydria (exsicosis) hyperproteinemia hypoproteinemia
Shock Def.: hypoperfusion of cells and tissues due to decrease of effective circulating volume
Shock - pathogenesis decreased cardiac output redistribution of blood decreased amount of blood decreased cardiac output redistribution of blood
Shock - types & causes cardiogenic hypovolemic (hemorrhage, fluid loss – burns, vomiting) septic (bacterial infections G- endotoxic, G+ septicemia) neurogenic (anesthesia,spinal cord injury)
Shock - stages progressive – cell derangement early (non progressive - reversible) progressive – cell derangement irreversible – cell death
Shock - morphology ischaemic encephalopathy shock lung shock kidney adrenal hypolipoidosis liver – centroacinar necroses pancreas focal necroses
Collapse Def.: temporary disproportion of the blood & vessels volume due to vasodilation (heat, psychogenic stimuli…) mostly self limited, can proceed to shock