​Pathology - Congestive Heart Failure

​Pathology - Congestive Heart Failure 
Congestive Heart Failure Causes:
Systolic: Ischemic heart disease, particularly myocardial infarction; hypertension; aortic and mitral regurgitation; dilated cardiomyopathy; myocarditis; hypertensive heart disease.
Diastolic: Ischemic heart disease, hypertension, diabetic heart disease, hypertrophic cardiomyopathy, restrictive cardiomyopathy, and aortic stenosis are conditions associated with diastolic dysfunction.
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A significant number of patients will exhibit indications of both systolic and diastolic heart failure, with up to 50% of patients potentially experiencing isolated diastolic heart failure.
Systolic: Reduced left ventricular ejection fraction causes a decrease in cardiac output, leading to dyspnea. Pulmonary edema occurs when the left ventricle fails to maintain the same level of output as the right ventricle, causing an increase in the leakage of fluid from the pulmonary arteries. Reduced right ventricular ejection fraction results in elevated central venous pressure, leading to hepatomegaly and peripheral edema.
Diastolic: The heart's inability to adequately fill with blood is caused by impaired ventricular compliance. This leads to a simultaneous rise in end ventricular diastolic pressure and a decline in cardiac output. When ventricular diastolic pressure rises, it is conveyed back to the pulmonary vasculature, causing an increase in fluid transudation from the pulmonary arteries and resulting in pulmonary edema.

Presenting Symptoms 
Patients may exhibit symptoms indicative of left-sided heart failure, such as dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and pleural effusion. Alternatively, they may present symptoms characteristic of right-sided heart failure, including fluid retention, peripheral edema, hepatosplenomegaly, ascites, and distention of neck veins. In some cases, patients may experience symptoms that are indicative of both left- and right-sided heart failure.

Treatment Diuretics, a low-sodium diet, ACE inhibitors, nitrates, B-blockers, and digoxin are used for management.
Cor pulmonale is a condition characterized by right-sided heart failure that occurs as a result of long-term pulmonary hypertension.