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OF HEART FAILURE
Prof. J. Hanacek
Notes to heart physiology
• Control of HR:
- autonomic nervous system
• Control of SV:
- preload, contractility, afterload, number and size of myocytes,
heart architecture, synchronisation of function of the atrias and
ventricles
Adaptive mechanisms of the heart
to increased load
• Ventricular hypertrophy
– increased mass of contractile elements strength
of contraction
Contractility of myocardium
Changes in ability of myocardium to develop force
by contraction that occurs independently on changes
in myocardial fibre length
• It is composed of 4 phases:
- filling of the ventricle
- isovolumic contraction of ventricle
- isotonic contraction of ventricle (ejection of blood)
- isovolumic relaxation of ventricle
Pressure – volume loops recorded under different
conditions
Afterload
Laplace law:
Definition
Disorders of preload
preload length of sarcomere is more than optimal
strength of contraction
Disorders of contractility
In the most forms of heart failure the contractility of myocardium
is decreased (ischemia, hypoxia, acidosis, inflammation, toxins,
metabolic disorders... )
A. MECHANICAL ABNORMALITIES
1. Primary
a) cardiomyopathy
b) myocarditis
2. Secondary
a) oxygen deprivation (e.g. coronary heart disease)
2. extreme tachycardias
3. extreme bradycardias
Pathomechanisms involved in heart failure
A. Pathomechanisms involved in myocardial failure
Endothelin
sensation of thirst
Secondary damage –
remodeling
Adrenergic, RAA,
cytokine systems are
involved in the remodeling
a) intramyocardial
– e.g. myocardial fibrosis, amyloidosis, hypertrophy,
myocardial ischemia...
1. forward failure:
symptoms result from inability of the heart to pump enough
blood to the periphery (from left heart), or to the lungs (from
the right heart)
Stimuli Pressure load in a disease setting Regular physical activity or chronic exercise training
(e.g. hypertension, aortic coarction) Volume load (e.g. running, walking, swimming)
or volume load (e.g. valvular disease) Pressure load (e.g. strength training: weight lifting
Cardiomyopathy (familial, viral, toxic,
metabolic)
Cardiac
morphology Increased myocyte volume Increased myocyte volume
Formation of new sarcomeres Formation of new sarcomeres
Interstitial fibrosis
Myocyte necrosis and apoptosis
Fetal gene
expression Usually upregulated* Relatively normal*
Cardiac
function Depressed over time Normal or enhanced
Completely
reversible Not usually Usually
Association with
heart failure
and increased Yes No
mortality
McMullen and Jennings, 2007