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A. CHF Pathophysiology 2.0

The document outlines the pathophysiology of Congestive Heart Failure (CHF) in a 60-year-old patient with a history of hypertension, left ventricular hypertrophy (LVH), and left ventricular dysfunction (EF 38%). It details the predisposing and precipitating factors contributing to the patient's condition, including age, family history, and previous medical events such as pneumonia and stroke. The progression of CHF is explained through a series of physiological changes, leading to symptoms like dyspnea, orthopnea, and peripheral edema.

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Ruthie Mendoza
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23 views4 pages

A. CHF Pathophysiology 2.0

The document outlines the pathophysiology of Congestive Heart Failure (CHF) in a 60-year-old patient with a history of hypertension, left ventricular hypertrophy (LVH), and left ventricular dysfunction (EF 38%). It details the predisposing and precipitating factors contributing to the patient's condition, including age, family history, and previous medical events such as pneumonia and stroke. The progression of CHF is explained through a series of physiological changes, leading to symptoms like dyspnea, orthopnea, and peripheral edema.

Uploaded by

Ruthie Mendoza
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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PATHOPHYSIOLOGY

Congestive Heart Failure (CHF) with Hypertensive Cardiovascular Disease

The patient is a 60-year-old individual presenting with dyspnea, orthopnea, and bipedal
edema, with a significant history of hypertension, left ventricular hypertrophy (LVH),
and left ventricular dysfunction (EF 38%). Previous medical events include pneumonia
(2005), an unspecified cardiac condition (2022), and a mild stroke later that year. The
patient also reports an intermittent bipedal edema and dyspnea, exacerbated by
exertion.

The step-by-step pathophysiological progression of congestive heart failure (CHF)


associated with hypertensive cardiovascular disease, left ventricular hypertrophy
(LVH), and left ventricular dysfunction.

Predisposing Factors (Risk Factors)


These are the baseline factors that increase the likelihood of developing CHF over time.

Age (60 years old)


As people age, the heart muscle naturally undergoes structural changes. Aging
decreases the heart's elasticity and ability to pump efficiently, predisposing older
individuals to cardiovascular diseases like hypertension and heart failure.

Family History (Sibling with brain tumor)


Although the sibling’s brain tumor is not directly linked to CHF, a family history of
health conditions suggests a possible genetic predisposition to systemic health issues,
including cardiovascular diseases.

Precipitating Factors (Triggering/Worsening Conditions)


These factors exacerbate existing conditions, accelerating the progression of heart
failure.

Hypertension (HTN)
Chronic high blood pressure forces the heart to pump harder to circulate blood. This
persistent stress leads to the thickening of the left ventricular wall (LVH), a hallmark of
hypertensive cardiovascular disease.

Past Pneumonia (2005)


Infections like pneumonia can place additional strain on the heart and lungs,
contributing to heart failure by increasing pulmonary pressures.

Cardiac Condition (2022, unspecified)


A history of cardiac events indicates prior heart damage, contributing to progressive
heart dysfunction.
Mild Stroke (2022, recovered)
Stroke may reflect systemic vascular disease, which can impair heart function through
overlapping risk factors (hypertension, atherosclerosis). Stroke can also lead to long-
term cardiovascular decompensation.

Left Ventricular Hypertrophy (LVH)


LVH results from prolonged hypertension. The thickened heart muscle reduces its
efficiency and flexibility, impairing diastolic filling and cardiac output.

Left Ventricular Dysfunction (EF 38%)


Ejection fraction (EF) measures how much blood the left ventricle pumps out with each
contraction. A normal EF is 55-70%, but this patient’s EF of 38% indicates reduced
systolic function, a key sign of heart failure.

Bipedal Edema and Dyspnea


Fluid retention and difficulty breathing are hallmark symptoms of CHF, reflecting
systemic and pulmonary congestion.

2-Pillow Orthopnea
Orthopnea (difficulty breathing while lying flat) suggests fluid buildup in the lungs, a
sign of left-sided heart failure.

Pathophysiological Process
This section details the sequential events leading to CHF.

1. Hypertension
Chronic high blood pressure increases afterload (resistance the heart must overcome to
pump blood). Over time, the left ventricle compensates by thickening, leading to LVH.

2. Left Ventricular Hypertrophy (LVH)


The thickened heart muscle has less room to relax and fill during diastole, impairing
diastolic function. This also increases the heart’s oxygen demand, risking ischemia
(reduced blood supply) and stiffness in the ventricular wall.

3. Left Ventricular Dysfunction (EF 38%)


Progressive LVH eventually affects systolic function, reducing the heart’s pumping
efficiency. This leads to a low ejection fraction (EF), characteristic of heart failure with
reduced ejection fraction (HFrEF).

4. Neurohormonal Activation
Sympathetic Nervous System (SNS)- In response to low cardiac output, the SNS
activates, increasing heart rate and vasoconstriction. This temporarily supports
circulation but further stresses the heart.

Renin-Angiotensin-Aldosterone System (RAAS)- RAAS activation promotes sodium


and water retention, raising blood volume. This increases preload (the volume entering
the heart), contributing to congestion.

5. Pulmonary and Systemic Congestion


Pulmonary Congestion- Elevated pressures in the left ventricle cause fluid to back up
into the lungs, leading to dyspnea (shortness of breath) and orthopnea.

Systemic Venous Congestion- Blood backs up into the veins, causing peripheral edema
(swelling in the legs and feet).

6. Congestive Heart Failure (CHF)


CHF is the endpoint of progressive left ventricular dysfunction. The heart is unable to
meet the body’s demands, resulting in symptoms like fatigue, dyspnea, and swelling.

Functional Class Symptoms


Functional classification describes the severity of CHF symptoms:

Dyspnea with exertion- Breathlessness during activity.

Fatigue- Reduced cardiac output leads to decreased oxygen supply to muscles.

Peripheral edema- Fluid buildup causes swelling, typically in the lower extremities.

Orthopnea- The need to elevate the head with pillows while sleeping to avoid
breathlessness.
Congestive Heart Failure with
Hypertensive Cardiovascular Disease

Predisposing Factors: Precipitating Factors:


-Age -Hypertension -Left Ventricular Hypertrophy
-Family History (Sibling with brain -Past Pneumonia -Left Ventricular Dysfunction
tumor) -Cardiac Condition -Bipedal Edema & Dyspnea
-Mild Stroke -2-Pillow Orthopnea

Hypertension

Left Ventricular Hypertrophy (LVH)

Left Ventricular Dysfunction (EF 38%)

 SNS (Tachycardia) Neurohormonal


 RAAS (Fluid Retention Activation

 Pulmonary Congestion  Dyspnea, Orthopnea


 Systemic Venous
Pulmonary and Systemic
Congestion  Bipedal Edema
Congestion

Congestive Heart Failure (CHF)

Functional Class Symptoms:


-Dyspnea with Exertion
-Fatigue
-Peripheral Edema
-Orthopnea

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