Left heart failure

1. LEFT HEART FAILURE

2. MECHANISM

3. HOW DOES THE PATIENT
PRESENTS WITH?
1. DYSPNOEA-INITIALLY EXERTIONAL THEN PROGRESSING
TO DYSPNOEA AT REST
GRADE I → GRADE IV
MECH:

4. • ↓PULM.COMPLIANCE
• ↑ AIRWAY RESISTANCE
• RESPIRATORY MUSCLE &DIAPHRAGM FATIGUE

5. 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

6. 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

7. 4.CARDIAC ASTHMA
PULM.EDEMA &BRONCHIAL WALL EDEMA
↓
WHEEZING
5.A/C PULM. EDEMA
-MARKED ELEVATION OF PULM. CAPILLARY PRESS.
↓
ALVEOLAR EDEMA
↓
COUGH WITH COPIOUS PINKISH FROTHY SPUTUM
&BILATERAL CREPITATION

8. 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.FATIGUE
9.MENTAL CONFUSION

9. 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 GALLOP
2. FINE BASAL CREPITATIONS
3. 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

10. • BP: ↓PULSE PRESSURE DUE TO REDUCED STROKE VOL.
HYPOTENTION
DBP SLIGHTLY RAISED
• IF CARDIOMEGALY –APEX SHIFTED OUTWARDS &
DOWNWARDS

11. 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