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General Pathology

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

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General Pathology

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  1. General Pathology Circulation Disorders - I Heart FailureManifestations & Causes Jaroslava Dušková Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague

  2. Manifestations of Circulatory Failure • in the heart • outside heart

  3. Manifestations of Circulatory Failure • in the heart • acute failure - dilation • chronic insuficiency - hypertrophy concentric,excentric • outside heart

  4. 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 Manifestations of Circulatory Failure outside heart

  5. venous pressure capillary pressure cardiac output arterial volume ADH renin Na & H2O retention plasma volume transudation EDEMA Cardiac Failure

  6. 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

  7. 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.)

  8. Causes of Circulatory Failure (1) • in the heart • endocardium • myocardium • pericardium • neurological reflex (syncope) • pressure changes • in pulmonary circulation • in body circulation • hypertension • hypotension – shock, collapse

  9. Cardiomyopathy Def.: specific (non ischaemic, non inflammatory) heart muscle disease leading to heart failure • hypertrophic (obstructive) • dilated (congestive) • restrictive (obliterative)

  10. 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.)

  11. Causes of Circulatory Failure (3) • in body circulation • hypertension • „essencial“ • renal • endocrine COR HYPERTONICUM COR BILATERALE • changed blood composition(cont.)

  12. changed blood composition anaemia plethora oligemia hyperphydremia anhydria (exsicosis) hyperproteinemia hypoproteinemia Causes of Circulatory Failure (4)

  13. Shock Def.: hypoperfusion of cells and tissues due to decrease of effective circulating volume

  14. Shock - pathogenesis • decreased amount of blood • decreased cardiac output • redistribution ofblood

  15. Shock - types & causes • cardiogenic • hypovolemic (hemorrhage, fluid loss – burns, vomiting) • septic (bacterial infections G- endotoxic, G+ septicemia) • neurogenic (anesthesia,spinal cord injury)

  16. Shock - stages • early (non progressive - reversible) • progressive – cell derangement • irreversible – cell death

  17. Shock - morphology • ischaemic encephalopathy • shock lung • shock kidney • adrenal hypolipoidosis • liver – centroacinar necroses • pancreas focal necroses

  18. Collapse Def.: temporary disproportion of the blood & vessels volume due to vasodilation (heat, psychogenic stimuli…) mostly self limited, can proceed to shock

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