Congestive Cardiac Failure or Congestive Heart Failure (CHF)- B. Pharma 2nd Semester Pathophysiology notes pdf

Congestive Cardiac Failure of Congestive Heart Failure (CHF)


       Congestive Cardiac Failure




At the end of this PDF Notes, student will be able to

       Define  congestive heart failure

       Discuss the types of congestive heart failure

       Explain the pathophysiology of congestive heart failure

       Discuss the signs and symptoms of it


       A clinical syndrome

       Result from any disorder that impairs the ability of the ventricle to fill with or eject blood

       Rendering the heart unable to pump blood at a rate sufficient to meet the metabolic demands of the body

       Heart failure can result from any disorder that reduces ventricular filling (diastolic dysfunction) and/or myocardial contractility (systolic dysfunction)

Etiology of Congestive Heart Failure

Systolic dysfunction (decreased contractility)

       Reduction in muscle mass (e.g. myocardial infarction)

       Dilated cardiomyopathies

       Ventricular hypertrophy

       Pressure overload (e.g. systemic or pulmonary    HT, aortic or pulmonic valve stenosis)

       Volume overload (e.g., valvular regurgitation, shunts, high-output states)

Diastolic dysfunction (restriction in ventricular filling)

       Increased ventricular stiffness

       Ventricular hypertrophy (e.g. hypertrophic cardiomyopathy)

       Infiltrative myocardial diseases (e.g. amyloidosis, sarcoidosis, endomyocardial fibrosis)

       Myocardial ischemia and infarction

       Mitral or tricuspid valve stenosis

       Pericardial disease (e.g. pericarditis, pericardial tamponade)

Types of Heart Failure

       Acute and chronic heart failure

       High output and low output HF

       Left sided, right sided and biventricular HF

       Forward and backward HF

       Systolic and diastolic HF 

Acute heart failure 

       Heart is not able to pump the blood effectively

       Also called as Decompensated heart failure

       Compensatory mechanisms  of human body cause increase in CO by stimulation of β1  receptors and  also RAA-system

       Both mechanism leads to vasoconstriction

       Treatment with Inotropic drugs becomes necessary

Chronic heart failure

       Failure of compensatory mechanism

       Heart needs to undergo surgery for its repair

       Further controlled by administration of drugs

High output HF:

       There is high demands of the body, which are not met even with increased cardiac output

       e.g.: anemia, pregnancy

Low output HF:

       There is decreased contractility of heart leading to decreased cardiac output

       e.g.: cardiomyopathy, valvular disease

Left sided (left ventricular) HF

        Excess fluid accumulates upstream

        Reduction in left ventricular output

        Increase in left atrial pressure

        Increase in pulmonary venous pressure

Ø  Acute increase in left atrial pressure causes pulmonary congestion and pulmonary edema e.g.: MI

Ø   Gradual increase in left atrial pressure causes reflex pulmonary hypertension but no pulmonary edema

e.g. : aortic stenosis

Right sided (right ventricular) HF:

         Excess fluid accumulates upstream behind the failing right ventricle  

         Reduction in right ventricular output

         Results in systemic venous congestion

   Ex: pulmonary valvular stenosis, multiple pulmonary emboli 

Systolic HF:

       Characterized by an abnormality of ventricular contraction

       As seen in ischemic heart failure and dilated cardiac myopathy

Diastolic HF:

       Characterized by an impaired ventricular relaxation

       Increased ventricular stiffness resulting in diastolic dysfunction

e.g.: ischemia, left ventricular hypertrophy

Pathophysiology of Congestive Heart Failure

Preload: Pressure that fills the left ventricle during diastole

       Main Determinant- left ventricular compliance and venous return

       Small increase in end-diastolic volume

       large increase in cardiac output

       Primary compensatory mechanism in normal heart

       Ability of heart to alter the force of contraction depends  on preload

Afterload: Pressure against which the left ventricular contracts and is measured as the mean aortic pressure 

  • Main determinants - total peripheral resistance and left ventricle size 
  • Left ventricular dysfunction - an inverse relationship exist between afterload and stroke volume
  • An increase in afterload causes a decrease in stroke volume

Key components of the pathophysiology of cardiac remodelling

Compensatory Mechanisms

Cardiac compensatory mechanism:

Ø  Ventricular dilation

Ø  Ventricular hypertrophy

Peripheral compensatory mechanisms:

Ø  Increased sympathetic activity

Ø  Activation of renin angiotensin aldosterone system

Ø   Increased release of arginine vasopressin

Renin Angiotensin Aldosterone system

Clinical Presentation – Signs of Congestive Heart Failure

       Pulmonary edema

        Pleural effusion



       Peripheral edema

        Jugular venous distension

        Hepatojugular reflux


Symptoms of Congestive Heart Failure



       Paroxysmal nocturnal dyspnea

        Exercise intolerance


       Ascites, Mental status changes





        Abdominal pain, Anorexia, Nausea, Bloating


       CHF is a clinical syndrome that impairs the ability of the ventricle to fill with or eject blood

       Heart is unable to pump blood at a rate sufficient to meet the metabolic demands of the body

       It can be classified as:  Acute and chronic heart failure,

       High output and low output heart failure,

       Left sided, right sided and biventricular heart failure,

       Systolic and diastolic heart failure

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