Cardiac insufficiency

Introduction

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What is cardiac insufficiency?

Cardiac insufficiency is a clinical syndrome which is characterized by the inability of the heart to pump well enough to supply all the tissues of the body with blood. Since the heart and peripheral vessels are functionally a joint system, one can also use the term cardiovascular insufficiency as well as cardiac insufficiency.

There are three types of cardiac insufficiency:

Left ventricle insufficiency
Right ventricle insufficiency
Global insufficiency

Depending on the progression of the disease, the insufficiency may be:

Acute
Chronic

Which are the causes of cardiac insufficiency?

The causes of cardiac insufficiency are multiple and include:

Determining factors
Factors which lead to the emergence of the disease

How does cardiac insufficiency?

The heart resembles a pump which distributes the blood through all the systems and organs in the body. The amount that the heart is capable of pumping every minute is termed the cardiac debit. This debit is not constant, but rather fluctuates according to the physiological needs of the organism. The capacity that the heart retains in order to increase the debit, depending on the needs of the organism, is called the cardiac reserve. In pathological cases, the potential energy of the heart is reduced, but the heart still attempts to withstand this phenomenon via the following three mechanisms:

Compensatory tachycardia

This occurs when the heart beats faster, hence increases its beat frequency (the number of beats per minute) in order to sustain the needs of organs and tissue for blood. However, this is only a temporary solution, since if the heart operates in this manner, it exhausts itself very quickly. In addition to this, the tachycardia leads to a shorter diastole (the ventricle is not completely filled with blood) which causes the systolic debit to become lower (less blood flowing to the periphery).

Enlargement (dilation) of the heart

Enlargement/dilation of the heart causes the myocardial fibres to elongate along the direction of the diastole more so than in a normal condition. According to the law of Starling, the systolic contraction is more powerful, hence the ventricles are completely empties, which is why the systolic debit is larger. This compensation mechanism has its limits, since when muscle fibres become more elongated, their contractile power is reduced.

Hypertrophy of the heart

The heart becomes hypertrophic which is the usual compensatory mechanism when the hemodynamic overload continues over a long or short period of time. Hypertrophy of the heart occurs when the myocardium fibres become thicker, while their numbers do not change. It should also be noted, that the hypertrophic fibres have upregulated needs for blood flow, but the capillary network remains unchanged.

This causes the development of a relative ischemia, which is the core of a future decompensation. When the compensatory mechanisms are capable of maintaining the cardiac debit at a level where the clinical pathological signs are not experienced, it is stated that the cardiovascular apparatus is compensated. In other cases, the compensatory mechanisms are so greatly diminished, that the heart muscle is not capable of fulfilling the tissues’ needs for blood flow, hence the clinical signs of cardiac insufficiency appear.

Medically Reviewed by a doctor on 19 Jun 2018
Medical Author: Dr. med. Diana Hysi

Articles for cardiac insufficiency

Introduction

Cardiac insufficiency is a clinical syndrome which is characterized by the inability of the heart to pump well enough to supply all the tissues of the body with blood. Since the heart and peripheral vessels are functionally a joint system, one can also use the term cardiovascular insufficiency as well as cardiac insufficiency.

Two pathogenic theories behind cardiac insufficiency

The reduction in contractile power of the myocardium causes the cavities of the heart to not be fully emptied, hence the residual systolic blood and the ventricular diastolic pressure rise. Alongside the aforementioned, the atrial pressure rises, and the flow of venous blood is obstructed.

Causes

The causes of cardiac insufficiency are multiple and include: determining factors, factors which lead to the emergence of the disease like extreme physical exertions, various infections such as acute pneumopathies, influenza, etc.

Classification

There are many cardiac insufficiency classifications being used. These classifications are used in order to help with a better understanding of the different stages and the treatment of the various stages.

Complications

Patients suffering from cardiac insufficiency are more predisposed to developing acute pneumopathy, which is favored for development due to pulmonary stasis; embolisms and pulmonary infarctions; bacterial endocarditis, etc.

Diagnosis

The diagnosis is based on the information collected from the patient history; organic cardiopathic signs such as dyspnea, pulmonary stasis, tachycardia, galloping rhythm, coughing with hemoptoic sputum etc, are all symptoms related to the left ventricle.

Treatment

Preventive non-drug based treatments include bed rest and diet. Drug based treatments vary across different stages, symptoms and various patients belonging to various age groups and specifications. Treatment is usually complex and involves utilizing drug combinations.

Symptoms (left venticular insufficiency)

Acute insufficiency of the left ventricle is characterized by dyspnea which occurs mostly at night, resembling cardiac asthma or acute pulmonary edema. The earliest symptom to emerge in chronic insufficiency of the left ventricle is dyspnea.

Diagnosis (left venticular insufficiency)

Upon conducting an examination of the heart, one can observe the left ventricle has been displaced to the bottom left, the heart sounds are muted, fast and a galloping rhythm and systolic noise can be heard at the apex of the heart as a consequence of the functional mitral insufficiency.

Types of cardiac insufficiency (right ventricle)

Acute insufficiency of the right ventricle usually emerges as a consequence of a pulmonary embolisms. Chronic insufficiency of the right ventricle patients complain of a feeling of heaviness or pain in the right hypochondrium.

Diagnosis (right chronic insufficiency)

Upon conducting a heart examination, it is noted that there is tachycardia, the heart sounds have become muted, there are galloping sounds and systolic rumours in the vicinity of the xiphoid process, which all indicate a functional insufficiency of the tricuspid valve.

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