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Chapter 2
•
Cardiovascular Care
35
STRUCTURAL DISORDERS
HEART FAILURE
Heart failure (HF) is a common
clinical syndrome caused by any
structural or functional cardiac
disorder that impairs the ability
of the ventricle to fill with or eject
blood. HF may be caused by disease
of the myocardium, pericardium,
endocardium, heart valves, vessels,
or by metabolic disorders.
*
The diagnosis of HF requires that two
major or one major and two minor criteria
be present concurrently. Minor criteria
were acceptable only if they could not be
attributed to another medical condition.
Major Criteria for Diagnosis of CHF
Minor Criteria for the Diagnosis of CHF
•
Paroxysmal nocturnal dyspnea
•
Neck vein distension
•
Pulmonary rales
•
Cardiomegaly on chest x-ray
•
Acute pulmonary edema
•
Third sound gallop
•
Increased central venous pressure (
>
I6 cm water at the right atrium)
•
Hepatojugular reflux
•
Pulmonary edema
•
Visceral congestion or cardiomegaly at autopsy
•
Weight loss
≥
4.5 kg in 5 days in response to treatment of CHF
•
Bilateral ankle edema nocturnal cough
•
Dyspnea on ordinary exertion
•
Hepatomegaly
•
Pleural effusion
•
Decrease in vital capacity by 33% from maximal value recorded
•
Tachycardia (rate
≥
I20 beats/min)
Type of HF
Causes
Morphologic Changes
Symptoms
Left Sided Heart
Failure
•
Ischemic Heart Disease
•
Hypertension
•
Aortic and mitral valvular diseases
•
Myocardial diseases
•
Congestion of the
pulmonary circulation
•
Stasis of blood in the left-
sided chambers
•
Hypoperfusion of
tissues leading to organ
dysfunction
•
Cough
•
Dyspnea (initially with exertion
and later at rest)
•
Orthopnea
•
Paroxysmal nocturnal dyspnea
•
Feeling of suffocation
•
Decreased cardiac output
•
Decreased renal perfusion
(prerenal azotemia)
•
Hypoxic encephalopathy
Right Sided
Heart Failure
•
Left sided failure
•
Variety of disorders that affect the lung
•
Cor pulmonale
•
Primary pulmonary hypertension
•
Recurrent pulmonary
thromboembolism
•
Chronic sleep apnea
•
Altitude sickness
•
Hypertrophy and dilation
of the right side of the
heart
•
Minimal pulmonary congestion
•
Systemic and portal venous
system congestion