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Types – Heart Failure

by Joseph Alpert, MD
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    00:00 see this dilatation of the left ventricle. Now, again, we talked about the different kinds of heart failure - systolic and diastolic, but sometimes there are definitions based upon which ventricle is in the most trouble. Most common is left sided heart failure. That’s because the left ventricle has been injured, but in some conditions such as severe lung disease with high pressures in the lung, you may just see isolated right sided heart failure.

    00:27 So, let’s think about this for a moment. With left sided heart failure, the backup is going to be into the lungs. Patients get fluid in the lungs and they’re short of breath. So, the edema is in the lungs with left sided heart failure.

    00:39 With right sided heart failure, the backup is into the veins. So, you often see patients with fluid in the abdomen, fluid in the legs, so called peripheral edema and the left ventricle may be working just fine, but it’s not getting any blood from the right ventricle because the right ventricle is failing. And of course, it’s obvious, what the left ventricle puts out depends on what the right ventricle puts out. They have to balance out. If they don’t balance out, all the blood is going to end up on one side of the circulation or the other.

    01:13 And then we’ve talked about before, systolic heart failure - failure of contraction; diastolic heart failure - failure of relaxation. Here’s just a little diagram to remind you how the whole body is a co-ordinated system. You see the brain is connected to the heart, the brain is connected to the kidneys, they're all connected to the peripheral blood vessels, and as we’ve talked about, when there’s heart failure or when there’s dehydration or when there’s hemorrhage, all of these factors become activated in an attempt to - A. Restore the blood volume and B. Restore the pumping ability of the heart.

    01:51 And here they are all listed again, just as we’ve talked about before, the central nervous system is critical. Sympathetic nervous system is activated. The kidney through the renin-angiotensin system is activated and the ventricle is… gets increased volume and therefore, uses the Starling mechanism. All of these things work together. They work great if the patient’s blood volume is down because of dehydration and hemorrhage; they work against you when the problem is that the heart is not pumping enough.

    02:22 And again, here you see a diagram that just shows you how all of these interact, how decreased cardiac output can lead to lung congestion and how increased peripheral pressure can lead to peripheral edema. The neurohormonal activations through the kidney that go on, all of these things are working in a complete circus motion like the horse riding around the track in the circus. Around and around, they keep reinforcing each other and unfortunately, in heart failure lead to marked retention of water and salt that leads to the various symptoms that the heart failure patient has. The American Heart Association guidelines talk about various levels of heart failure. Level A is somebody who’s really predisposed to heart failure, but has not developed it yet. So, that’s somebody with high blood pressure, diabetes, hypercholesterolemia - hyperlipidemia, as we’ve talked about, that leads to atherosclerosis. Heart failure hasn’t developed yet, but the substrate, if you will, is ready to go on and cause a heart condition that will lead to heart failure.

    03:35 Grade B is when you’re starting to have some very early signs of heart failure by some of our fancy test such as from the echocardiogram, but the patient is still asymptomatic.

    03:48 Stage C is when the patient is already having symptoms. They’re tired, they’re short of breath, they have peripheral edema. And stage D is when they’re really incapacitated with heart failure, marked severe symptoms of heart failure.


    About the Lecture

    The lecture Types – Heart Failure by Joseph Alpert, MD is from the course Introduction to Cardiac Diseases.


    Included Quiz Questions

    1. Right sided heart failure
    2. Diastolic heart failure
    3. Systolic heart failure
    4. Left sided heart failure
    5. Systolic and Diastolic heart failure
    1. Left-sided heart failure
    2. Right-sided heart failure
    3. Both Systolic and Diastolic heart failure
    4. Systolic heart failure
    5. Diastolic heart failure
    1. Right sided heart failure
    2. Diastolic heart failure
    3. Systolic heart failure
    4. Left sided heart failure
    5. Systolic and Diastolic heart failure
    1. Left-sided heart failure
    2. Right-sided heart failure
    3. Both Systolic and Diastolic heart failure
    4. Systolic heart failure
    5. Diastolic heart failure

    Author of lecture Types – Heart Failure

     Joseph Alpert, MD

    Joseph Alpert, MD


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