Additional methods of examination

ECG: in II, III standard leads - P-pulmonale, in V¹, V² - signs of overloading of the right ventricle.

Chronic heart failure Chronic left ventricular heart failure

Chronic left ventricular heart failure is characterized by congestion in lesser circulation due to the decreasing contractility of the left ventricle.

Etiology

1. Hypertension;

2. Symptomatic hypertension;

3. Ischemic heart disease;

4. Aortic valve disease;

5. Atherosclerotic cardiosclerosis;

6. Postinfarction cardiosclerosis;

7. Cardiomyopathy.

Pathogenesis. Etiological factor is development of prolonged venous congestion in the lesser circulation, which stimulates growth of connective tissue in the lungs and sclerosis of the vessels. At the increased pulmonary capillary pressure the elastic ability of lungs is decreased, disorders of ventilation occur. The respiratory centre is stimulated by accumulating under-oxidized metabolites in the blood-lactic acid, bicarbonate alkalis and carbon dioxide. Relevant to increasing content of the reduced hemoglobin in capillary blood appear acrocyanosis. As a compensatory mechanism may be tachycardia.

Clinical features

The patients complain on weakness, decreased work capacity, breathlessness, cough, firstly dry, later with sputum.

Objective examination. Patient's condition and consciousness is defined by stage of pathological process. Posture is forced in patients with pronounced heart failure. As usually the orthopnea is observed. The skin is pale and cold, acrocyanosis, trophic disturbances as a rule on the legs.

Objective examination of the respiratory system. The hemoptysis is observed, as a result of rupture of bronchial overfilled arterioles. Tachypnea is determined. At night time may be the attacks of cardiac asthma, transformed in pulmonary edema. Intermediate sound is detected over the lower lobes of the lung. In auscultation decreased vesicular breathing and moist rales in the posterior-inferior parts on the lung are determined.

Objective examination of the cardiovascular system. Apex beat is displaced to the left. The left border of the relative cardiac dullness displaced to the left. The both heart sounds decreased at the apex. Second sound over the pulmonary artery is accentuated.

Additional methods of examination

ECG - hypertrophy of left ventricle, left bundle branch block.

X-ray examination - congestion in lung.

Echocardiography - hypertrophy of left ventricle.

Chronic left atrial heart failure

Chronic left atrial heart failure is due to overloading of left atrium mostly in case of mitral stenosis and mitral regurgitation in late stage. The clinical features resemble the chronic left ventricular heart failure.

Chronic right ventricular heart failure Etiology

- venous congestion in lungs (chronic left ventricular failure);

- chronic lung diseases;

- congenital heart defects;

- tricuspid regurgitation;

- stenosis of pulmonary valve orifice;

- kyphoscoliotic chest.

Pathogenesis. As a result of pronounced hemodynamic overload appear the decrease of right ventricle pump function, dilation of right ventricle, relative incompetence of tricuspid valve, that lead to the elevation end-diastolic volume and venous pressure at right ventricle, right atrium, peripheral veins and capillaries. The central venous pressure is pronouncedly increased. Prolonged venous congestion leads to the enlarged liver, edema, ascites, and transudation of fluid into the pleural cavity and pericardium.