↓ EF (↓ SV)
(Systolic dysfunction:
ventricle can’t
squeeze/empty well)
↑ Afterload
(chronic pressure
overload, resisting
forward flow)
Severe
Hypertension
↓ Ventricle filling
(↓ Diastolic relaxation or
↑ ventricular stiffness)
↓ contractility
(abnormal, fibrotic,
or dead myocytes)
LV hypertrophy
Advanced Aortic
Stenosis
Left Heart Failure
Pathophysiology of Heart Failure
Keep the normal cardiac physiology in mind:
SV depends on preload, afterload, & contractility
Ventricular end-diastolic volume equates with preload
and depends on chamber compliance
Ventricular end-systlic volume depends on afterload and
contractility, not preload.
Preserved EF (↓EDV, so ↓SV)
(Diastolic Dysfunction:
ventricle doesn’t relax/fill well)
Heart Failure Definition + Epidemiology:
When heart 1) is unable to pump enough blood forward to meet metabolic demands, and/or 2)
pumps blood only when filling pressure is abnormally high.
The most severe manifestation of almost every form of heart-disease, often a combination of
diastolic and systolic dysfunction.
The most common “diagnosis” of hospital patients >65 yrs old
Poor prognosis: 1-yr mortality of 33%
CAD (MI, or transient
myocardial ischemia)
Chronic Volume
Overload (mitral
+ aortic regurge)
Dilated
Cardiomyopathies
Restrictive
Cardiomyopathy
Myocardial
Fibrosis
Transient myocardial
ischemia
Cardiac tamponade
Right Heart Failure
(Occurs when RV afterload ↑↑↑)
Pulmonary Parenchymal Disease
COPD
Interstitial Lung Disease (i.e. Sarcoidosis)
Acute Respiratory Distress Syndrome
Chronic lung infection/bronchiectasis
Pulmonary Vasculature Disease
Acute pulmonary embolism
Primary pulmonary hypertension
Cardiac Disease
Left-side heart failure
(most c ommon cause of RV failure)
Pulmonic Valve Stenosis
Right Ventricular infarction
Isolated RH failure (resulting from a
pulmonary process) is called “Cor Pulmonale”
Hypertrophic
Cardiomyopathy
EF = Ejection
Fraction
= SV/EDV
(normal = 55-75%)
Yan Yu, 2012 (www.yanyu.ca)
