DIFFERENTIATE:1. HIGH AND LOW OUTPUT FAILURERIGHT AND LEFT SIDED HEART FAILURESYSTOLIC FROM DIASTOLIC DYSFUNCTION

Question 9

Output Failure

Low Output Failure• Due to high systemic vascular

resistance– Coronary artery disease

• MI, Ischemia– Chronic pressure overload

• HPN, Obstructive Valvular Disease– Chronic volume overload

• Regurgitant Valvular Disease, L-R shunt, Extracardiac shunting

– Non-ischemic dilated cardiomyopathy• Viral disease

– Disorders of rate and rhythm• brady/ tachyarrhythmia

High Output Failure• Due to low systemic

vascular resistance– Metabolic disorders

• Thyrotoxicosis, Nutritional Disorders (Beri-beri)

– Excessive blood-flow requirements• Anemia, Pregnancy, AV

fistula

Patient has Low Output Failure

Symptoms based on Sided of Failure

Right-Sided• Edema (Feet and sacral

area)• Nocturia • Ascites • Hepatomegaly

– Jaundice, coagulopathy

• Systemic venous distention

Left-Sided• Aortic regurgitation

(ventricle hemodynamically overloaded)

• Dyspnea, orthopnea, PND, (pulmonary congestion)

Signs based on Side of Failure

Right-Sided• Pitting edema• Ascites• Hepatomegaly• Increased JVP• Parasternal heave

Left-Sided• Tachypnea or increase WOB• Rales or crackles• Pulmonary edema• Cyanosis• Laterally displaced apex

beat• Gallop rhythm• Heart murmurs (AS or MR)

Dysfunction

Systolic• Impaired contraction

– Inadequate cardiac output: weakness, fatigue, reduced exercise tolerance

Diastolic• Impaired relaxation (EF

>50%)– Elevated filling pressure/

volume overload: elevated JVP

– Increase in pulmonary capillary pressure : Dyspnea

Index event

Activation of neuro- hormonal systems

Sustained neuro- hormonal activation: impaired contraction

Ischemia

Reduced ATP: Slowed myocardial relaxation

LV filling is delayed because LV compliance is reduced