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