So let's break down congestive heart failure.
We've already said that the heart's not able
to or it's not strong enough to efficiently pump
an adequate amount of volume
of blood to the rest of the body.
Then fluid begins to back up within the circulation.
After the fluid builds up in the lungs,
and it begins to fill the alveoli with fluid.
pSo now instead of alveoli, you got
a little water balloons in your lungs, okay.
Now I know that's a concept you've probably heard before,
I want to invite a friend help us understand this even more.
This is a friend from my childhood.
I love this game, oh wagga wagga wagga wagga wagga
wagga wagga wagga, maybe you recognize it, yeah I know.
You've probably played in some really cool
retro places but I'm gonna use this little guy
to walk us through the flow of blood so you're rock
solid on what happens in congestive heart failure.
Okay, so this is gonna involve your pencil or
your finger because I want you to trace the blood
with our little friend there, our
tour guide through the system.
Now in a normal pump, I'm talking about a heart
and a system that's working efficiently, right?
There's no problems, the heart hasn't had a
heart attack because you know in a heart attack,
you end up myocardial infarction, you end up with
dead tissue and a dead tissue is stiff tissue.
So stiff tissue doesn't expand and contract efficiently,
that's another cause of CHF - a heart that's taken a hit.
We're not looking at a heart like that, we're
gonna look at a normal, healthy functioning heart.
Okay, so a normal pump - that's what we're looking at.
So unoxygenated blood, put your finger right on my
little friend there, the little Pac-Man-like guy.
Put your finger right there.
No I'm serious.
Don't just listen to my voice, get your body involved,
that's a great way to remember information in your brain.
Okay, so this is unoxygenated blood
returning to the heart on the right side.
Now our little friend there is
coming up from the bottom, right?
It's coming up from my legs
but you have your finger there.
If you trace it in, remember you also have
unoxygenated blood coming down from your head too
so you see you got those two
vessels, so trace those two vessels -
the superior and the inferior
coming back to the right atrium.
Alright, now the unoxygenated blood
enters the heart at the right atrium.
So make sure you got that clear in your mind, it's
coming from my lower extremities and down from my head,
now I'm in the right atrium.
Now after that, do you remember the
name of the valve that it goes through?
Okay, cool if you're not really solid on heart anatomy,
you will be by the time we're done with this video series.
So the unoxygenated blood came in my right
atrium, now we're down in the right ventricle.
The valve that it passes
through is the tricuspid valve.
Now tri- sounds like right to me so that's how I always remember
that the tricuspid valve is on the right side of the heart
So right atrium, unoxygenated blood through
the tricuspid valve into the right ventricle.
So you got your finger there,
you see that's where we are.
Now for the right ventricle, the blood
travels with the pulmonary artery into the lungs.
Ooh, okay so look at that, we kinda
stretched it out for you so you can see it.
You know you're, this isn't exactly what
it would look like compacted in your body
but it's a great way for you to grasp the concepts.
Right atrioum - tricuspid valve - right ventricle,
to both the lungs, the right and left lungs.
So right ventricle pushes unoxygenated
blood through the pulmonary artery.
Remember it's called the pulmonary artery
because it's taking blood away from the heart.
That's why its name is artery,
going to the lungs to get oxygenated.
So strong functioning heart: unoxygenated blood - right
atrium through the tricuspid valve - right ventricle
then it goes to both the right and the left lungs.
Now the blood picks up oxygen in the lungs, yeah that's
a good thing and it comes back to the heart on both sides.
So you're coming back from both the
right and the left lung to the left atrium.
Okay, so in the left atrium, it's going to pass
through the mitral valve into the left ventricle.
Okay, right atrium - tricuspid - right ventricle
- both the lungs, right to get oxygenated,
comes back to the left atrium, goes
through the mitral valve into that left ventricle.
Now the left ventricle's job is to
send blood out to up and down, right?
UP to my brain, DOWN to the
rest of my body carrying oxygen.
Alright, so we've got that just
a quick review of heart anatomy.
Now pause the video, and see if you can trace up blood
naming the valves, naming whether it's oxygenated or not.
Trace it all the way from the brain and the body, all
the way through the left ventricle back out to the body.
Okay, welcome back.
I hope you took advantage of doing that a couple times
because don't make the mistake that a lot of us make.
We think, yeah yeah yeah that
makes sense now why she's saying it.
Yeah, of course it does because
it's like we're singing karaoke, right?
I'm the words on the screen and you're
going along with me and it makes sense
but that doesn't mean you've
encoded it in your brain yet.
So you're capable of it, more than capable of
understanding the stuff but it takes time and repetition.
So make sure you've paused it, you've done it multiple times,
you have it rock solid without even having to look at it.
You can picture it in your own mind, then
you know you're ready to move forward.
Alright, now let's talk about congestive heart failure, this
is when it is not a healthy, strong functioning normal pump.
This heart is having problems that's
why we call it congestive heart failure.
This means the heart is failing and congestive, it's like
if your nose is all stuffed up, that's one of the problems.
That's the same thing with congestive heart failure - things
are backing up, things are swollen, the heart is failing.
So you've got a normal heart and a
congestive heart failure heart right there.
See you've got that thickening of
that ventricular chamber, that wall.
Now see if you can recall why did that happen?
What is one chronic problem that could be a big
factor in causing a thick left ventricular wall?
Cool! Did you remember that it's hypertension?
Right, if that left ventricles have to work really hard
because all the vessels in my body are clamped down,
that means the afterload or the workload of the
heart has pushed the blood out through those vessels
then that's a higher afterload, it gets
thicker which is helpful initially but remember,
then it's too much of a good thing and the heart
becomes stiff and not able to really fully empty.
So in CHF, that's why the heart can't keep up.
It can't pop strong enough to keep that
good balance so fluid begins to back up.
Now, you already know the answer
to my next question, you really do.
If you walked with me through the other stuff, if you've
pause the video and you've practiced, you've got this.
So here's where your extra
effort is really going to pay off.
Okay, so let's rewind, we're going to talk
about what happens in congestive heart failure.
So normally, when we look at this
slide, remember where the blood is gone.
I know, let's go through it just one more time.
Remember blood comes from
here and here into my right atrium.
then it goes to the valve, the tricuspid
valve then it's in the, right - right ventricle
then it goes to, yep - the lungs, dump off that CO2,
pick up the oxygen, come back to the left atrium.
Okay, now we're all together.
You see our guide, it's right there in the left atrium.
Then the blood that's now been oxygenated, right?
It's coming back to the pulmonary vein
because veins ring blood back to the heart.
Now it should move through the mitral valve into the left
The problem is, in a normal heart, it would pump it out
through the rest of the body, everything would be wonderful.
No, that's not what happens
sadly in congestive heart failure.
This heart has a ventricle that's not strong enough to
efficiently pump out blood out to the rest of the body.
Okay, now we have a real problem.
That's critically important that that left ventricle be
strong enough to push blood out to the rest of the body.
Congestive heart failure - it's not.
so what happens?
What happens when a ventricle
can't pump blood out efficiently?
Well, blood backs up where?
Well, the next likely spot is
gonna be the left atrium, right?
It's gonna go backwards.
It's supposed to be going this way but now it's
gonna back up so it's gonna go into the left atrium
and it's gonna back up into both of the lungs.
Aaah, since that left ventricle is not strong enough
to keep blood moving the direction it's supposed to go,
it's gonna start backing up.
Now when it starts backing up, you're
gonna have extra fluid hanging around
and seeping out of the blood
tissue, right? Into the tissues.
So we've got extra fluid volume seeping
out of the blood supply into the tissues.
When we're talking about
the lungs, those are the alveoli.
So those little alveoli, they're supposed to be
these open little balls that exchange CO2 for O2
now become water balloons.
Alright, so that is one of the
primary causes of pulmonary edema.
Now before you go on, I want you to just
pause the video go back and review that and see if,
pretend you're trying to teach someone else why
congestive heart failure causes pulmonary edema.
Just do it one more time and I
promise you'll have it down solid.