Transcript 10 circ insuff - Univerzita Karlova v Praze

General Pathology
Circulation
Disorders - I
Heart Failure
Manifestations
& Causes
Jaroslava Dušková
Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague
Manifestations
of Circulatory Failure

in the heart

outside heart
Manifestations
of Circulatory Failure
 in
the heart
– acute failure
– chronic insuficiency -
dilation
hypertrophy
concentric, excentric
 outside
heart
Manifestations
of Circulatory Failure outside heart
Acute
 capilarovenous
congestion
 acute venostasis
 cyanosis
(5g%
of red. hemoglobin!)
 cardial hydrops
edema
Chronic
 cyanotic induration
(spleen, liver, kidney)
 red
induration
(lung)
 venostatic
catarrh
 vessels hypertrophy
 cardial hydrops edema
Cardiac Failure
venous pressure
capillary pressure
cardiac output
arterial volume ADH
renin
Na & H2O retention
plasma volume
transudation
EDEMA
Hypertrophic Heart
mechanic and paracrine stimuli
 changed geometry concentric &
excentric hypertrophy
 decreased capillary myocytes ratio
 myocytes & interstitial tissue composition changes

– fetal proteins synthesis – beta myosin
– early genes induction c-myc, c-fos, c-jun


decreased beta- adrenergic receptors
increased oxygen consumption
HEART FAILURE
Causes of Circulatory Failure (1)
 in
the heart
– endocardium (malformations, fibroelastosis)
– myocardium
(cardiomyopaties,inflammations,
hypoxia, tumor, trauma)
– pericardium
(inflammations, synechiae, tumors,
hemopericardium)
– neurological reflex
(syncopa)
 in
pulmonary circulation
 in body circulation
(cont.)
Causes of Circulatory Failure (1)
 in
the heart
– endocardium
– myocardium
– pericardium
– neurological reflex
 pressure
changes
– in pulmonary circulation
– in body circulation
 hypertension
 hypotension
– shock, collapse
(syncope)
Cardiomyopathy
Def.:
specific (non ischaemic, non inflammatory)
heart muscle disease leading to heart failure



hypertrophic (obstructive)
dilated (congestive)
restrictive (obliterative)
Causes of Circulatory Failure (2)
 in
pulmonary circulation
– acute pulmonary hypertension
(pneumonia, pleuritis, embolism)
– chronic pulmonary hypertension
(emphysema, fibrotising processses)
COR PULMONALE acutum seu chronicum
 in
body circulation
(cont.)
Causes of Circulatory Failure (3)
 in
body circulation
– hypertension
„essencial“
 renal
 endocrine
COR HYPERTONICUM
COR BILATERALE
 changed blood composition

(cont.)
Causes of Circulatory Failure (4)
 changed
blood
composition
– anaemia
– plethora
– oligemia
– hyperphydremia
– anhydria (exsicosis)
– hyperproteinemia
– hypoproteinemia
Shock
Def.:
hypoperfusion of cells and tissues
due to decrease of effective
circulating volume
Shock - pathogenesis
– decreased amount of blood
– decreased cardiac output
– redistribution of blood
Shock - types & causes
– cardiogenic
– hypovolemic (hemorrhage, fluid loss –
burns, vomiting)
– septic (bacterial infections
G- endotoxic, G+ septicemia)
– neurogenic (anesthesia,spinal cord injury)
Shock -
stages
– early (non progressive - reversible)
– progressive – cell derangement
– irreversible – cell death
Shock -
morphology
– ischaemic encephalopathy
– shock lung
–
shock kidney
– adrenal hypolipoidosis
– liver – centroacinar necroses
– pancreas focal necroses
Collapse
Def.:
temporary disproportion of the blood &
vessels volume due to vasodilation
(heat, psychogenic stimuli…)
mostly self limited, can proceed to shock