1. Heart Failure Manifestations & Causes
General Pathology
Circulation
Disorders - I
Heart Failure Manifestations & Causes
Jaroslava Dušková
Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague

2. Manifestations of Circulatory Failure
in the heart
outside heart

3. Manifestations of Circulatory Failure
in the heart
acute failure dilation
chronic insuficiency hypertrophy
concentric, excentric
outside heart

4. 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

5. Cardiac Failure venous pressure capillary pressure cardiac output
arterial volume ADH
renin
Na & H2O retention
plasma volume
transudation
EDEMA

6. 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

7. 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.)

8. 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

9. Cardiomyopathy
Def.:
specific (non ischaemic, non inflammatory) heart muscle disease leading to heart failure
hypertrophic (obstructive)
dilated (congestive)
restrictive (obliterative)

10. 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.)

11. Causes of Circulatory Failure (3)
in body circulation
hypertension
„essencial“
renal
endocrine
COR HYPERTONICUM
COR BILATERALE
changed blood composition (cont.)

12. Causes of Circulatory Failure (4)
changed blood composition
anaemia
plethora
oligemia
hyperphydremia
anhydria (exsicosis)
hyperproteinemia
hypoproteinemia

13. Shock
Def.:
hypoperfusion of cells and tissues due to decrease of effective circulating volume

14. Shock - pathogenesis decreased cardiac output redistribution of blood
decreased amount of blood
decreased cardiac output
redistribution of blood

15. Shock - types & causes cardiogenic
hypovolemic (hemorrhage, fluid loss – burns, vomiting)
septic (bacterial infections
G- endotoxic, G+ septicemia)
neurogenic (anesthesia,spinal cord injury)

16. Shock - stages progressive – cell derangement
early (non progressive - reversible)
progressive – cell derangement
irreversible – cell death

17. Shock - morphology ischaemic encephalopathy shock lung
shock kidney
adrenal hypolipoidosis
liver – centroacinar necroses
pancreas focal necroses

18. Collapse
Def.:
temporary disproportion of the blood & vessels volume due to vasodilation (heat, psychogenic stimuli…)
mostly self limited, can proceed to shock