2. Normal Heart
• Weight of the heart varies with body weight & height.
• Males: 300 to 350 grams
• Females: 250 to 300 grams
• Usual thickness of
• Right Ventricle: 0.3 to 0.5 cm
• Left Ventricle: 1.3 to 1.5 cm
Hypertrophy: Greater heart weight or Ventricular thickness
Dilation: Enlarged chamber size
Cardiomegaly: Increase in cardiac weight or size owing to hypertrophy
and/or dilation
5. • A complex clinical syndrome that can result from any
structural or functional cardiac disorder that impairs the
ability of the ventricle to fill with or eject blood.
• Four Basic Mechanisms
• Increased Blood Volume (Excessive Preload)
• Increased Resistant to Blood Flow (Excessive Afterload)
• Decreased contractility
• Decreased Filling
8. Compensated Heart Failure
• Frank-Starling mechanism, in which increased filling volumes
dilate the heart and thereby increase subsequent actin-myosin
cross-bridge formation, enhancing contractility and stroke
volume
• Myocardial adaptations, including hypertrophy with or without
cardiac chamber dilation …ventricular remodeling
• Activation of neurohumoral systems to augment heart function
and/or regulate filling volumes and pressures.
• Release of norepinephrine by adrenergic cardiac nerves of the
autonomic nervous system
• Activation of the renin-angiotensin-aldosterone system
• Release of atrial natriuretic peptide.
14. Decompensated Heart Failure
• Compensatory mechanisms may restore CO to near-normal.
• But, if excessive, the compensatory mechanisms can worsen
heart failure because . . .
• Vasoconstriction: ↑ afterload
• Na and water retention: ↑ preload
• Excessive tachycardia: ↓ diastolic filling time → ↓ CO
15.
16. Not types, but characteristics of CHF.
FORWARD FAILURE
Variable degrees of decreased
cardiac output and tissue
perfusion.
BACKWARD FAILURE
Pooling of blood in the venous
capacitance system
17.
18. Usually CHF is the common end stage of many
forms of chronic heart disease.
Chronic Acute
Coronary Artery Disease
Hypertensive HD
Rheumatic Heart Disorders
Congenital Heart Disorders
Cor pulmonale
Cardiomyopathy
Anemia
Bacterial endocarditis
Valvular disorders
Acute MI
Arrhythmias
Pulmonary emboli
Thyrotoxicosis
Hypertensive crisis
Rupture of papillary muscle
VSD
Myocarditis
19.
20.
21.
22. Left Sided Heart Failure
• Lungs
• pulmonary congestion and edema
• heart failure cells
• Kidneys
• pre-renal azotemia
• salt and fluid retention
• renin-aldosterone activation
• natriuretic peptides
• Brain
• Irritability, decreased attention, stupor
• coma
42. Dilated
Cardiomyopathy.
Four chamber dilatation
and hypertrophy are
evident.
There is granular mural
thrombus at the apex of
the left ventricle (white
arrow).
The coronary arteries
were unobstructed.
12-32
46. Hypertrophic Cardiomyopathy with
asymmetric septal hypertrophy
The septal muscle bulges into the left ventricular outflow tract, and
the left atrium is enlarged.
12-
34
Banana-like
configuration
of left
ventricular
cavity due to
asymmetrical
septal
hypertrophy
12-
34
LA
LV
47. Hypertrophic Cardiomyopathy:
Histologic appearance demonstrating disarray, extreme
hypertrophy and characteristic branching of the myocytes as
well as interstitial fibrosis characteristic of the hypertrophic
cardiomyopathy.
12-34 B
48. Restrictive Cardiomyopathy
• It is a rare entity with multiple etiologies marked by a
restriction of ventricular filling leading to reduced cardiac
output.
• Interstitial myocardial fibrosis is usually present.
• Specific entities include:
• Endomyocardial fibrosis
• Loeffler endocarditis
• Endocardial fibroelastosis
• Restrictive cardiomyopathy can be idiopathic or associated
with distinct diseases that affect the myocardium (radiation
fibrosis, amyloidosis, sarcoidosis, metastatic tumors, products
of inborn error of metabolism, iron overload).