left heart failure
TRANSCRIPT
LEFT HEART FAILURE
MECHANISM
HOW DOES THE PATIENT PRESENTS WITH?
1. DYSPNOEA-INITIALLY EXERTIONAL THEN PROGRESSING TO DYSPNOEA AT REST
GRADE I → GRADE IV MECH:
• ↓PULM.COMPLIANCE• ↑ AIRWAY RESISTANCE• RESPIRATORY MUSCLE
&DIAPHRAGM FATIGUE
2.ORTHOPNOEA• DYSPNOEA OCCURING IN
RECUMBENT POSITION• RELIEVED BY SITTING UPRIGHT
OR SLEEPING ON ADDITIONAL PILLOWS
• NOCTURNAL COUGH MAY BE PRESENT
• MECH:-REDISTRIBUTION OF FLUID FROM SPLANCHNIC CIRCULATION &LOWER EXTREMITIES IN TO CENTRAL CIRCULATION→
INCREASE IN PULM. CAPILLARY PRESSURE
- ELEVATION OF DIAPHRAGM
3.PAROXYSMAL NOCTURNAL DYSPNOEA• A/C EPISODES OF DYSPNOEA
&COUGHING OCCURING AT NIGHT WHICH AWAKEN THE PATIENT FROM BED 1-3 HRS AFTER HE RETIRES
• PERSISTS EVEN AFTER SITTING UPRIGHT
• MECH:-DEPRESSION OF RESP. CENTRE DURING SLEEP
-REDUCED ADRENERGIC STIMULATION OF MYOCARDIUM AT NIGHT
4.CARDIAC ASTHMA PULM.EDEMA &BRONCHIAL WALL EDEMA ↓ WHEEZING5.A/C PULM. EDEMA -MARKED ELEVATION OF PULM.
CAPILLARY PRESS. ↓ ALVEOLAR EDEMA ↓ COUGH WITH COPIOUS PINKISH FROTHY
SPUTUM &BILATERAL CREPITATION
6.CHEYNE STOKES RESPIRATION• PERIODIC BREATHING WITH
ALTERNATE PERIODS OF APNOEA & HYPERVENTILATION
• MECH:-DIMINISHED SENSITIVITY OF RESP. CENTRE TO ARTERIAL PCO2
7.CENTRAL & PERIFERAL CYANOSIS
8.FATIGUE9.MENTAL CONFUSION
3. CARDINAL SIGNS OF LVF
1. GALLOP RHYTHM S1+S2+S3 OR S1+S2+S4----TRIPLE RHYTHM S1+S2+S3+S4-----QUADRUPLE RHYTHM IF S3 &S4 MERGE ----SUMMATION GALLOP2. FINE BASAL CREPITATIONS3. PULSUS ALTERANS—WHEN THE ALTERNATE
PULSES ARE WEAK.[LOW VOL.] BUT RHYTHM IS NORMAL
-BETTER FELT IN RADIAL A -HEALTHY &DEGENERATED MUSCLE FIBRES
PRODUCING NORMAL &WEAK BEAT RESPECTIVELY[DEFECTIVE ELECTROMECHANICAL COUPLING]
-POOR PROGNOSIS
• BP: ↓PULSE PRESSURE DUE TO REDUCED STROKE VOL.
HYPOTENTION DBP SLIGHTLY RAISED• IF CARDIOMEGALY –APEX
SHIFTED OUTWARDS & DOWNWARDS
CHEST X–RAY FINDINGS• PROMINANT UPPER LOBE VEINS• KERLEY B LINES – HORIZONTAL LINES IN
COSTOPHRENIC ANGLES- THICKENED INTERLOBULAR SEPTA & ENGORGED PERIPHERAL LYMPHATICS IN LOWER LOBE
• BAT’S WING-INCREASED BRONCHOVASCULAR MARKINGS[INVERTED MOUSTACHE SIGN]
• CARDIOMEGALY• PLEURAL EFFUSION