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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