Lung disease can affect the heart through structural changes of pulmonary vasculature, hypoxia or peripheral circulartion admixture, increased cardiac output or volume, elevation of ventricular or pulmonary vasculature. This is why it is important to discuss with your doctor about the various differentials if congestive heart failure is being considered.
Heart failure is a clinial syndrome in which the heart is unable to pump blood at a rate adequate to meet metabolic needs at the tissue level. Heart failure is characterized by abnormal cardiac muscle performance resulting in myocardial dysfunction and peripheral circulation changes (vasoconstriction).
Low Ouput CHF
Inability of heart to deliver blood adequate for existing metabolic needs without elevation of filling pressure. Depressed ejection fraction on echocardiogram is characteristic (<55% EF). With low output failure, systolic and diastolic dysfunction usually co-exist resulting in contractile and relaxation issues of the heart muscle. Diastolic dysfunction alone is fairly uncommon.
Although a neurohormonal pathophysiology component exists within the renin-angiotensin and sympathetic nerous system, etiology of low-output failure can be multiple:
- Systemic hypertension
- CAD
- Valvular heart disease
- Primary myocardial disease
- Rheumatic heart disease
- Congential heart disease
As a result the symptoms may include: Dyspnea, orthopnea, fatigue, swelling, palpitations.
Physical examination by a medical professional may reveal: Pulmonary rales and cardiac gallops on auscultation, edema, ascites and cardiac enlargement.
Recommendations include:
- Salt restriction
- Diuretic
- ACE Inhibitor
- Digitalis
- Beta blocker
- Treatment of underlying cause
High Output CHF
Although this is a much less common form of CHF, high output congestive heart failure is a secondary disease form. Here it shares the same pathophysiological properties of low output failure: Inability of the heart to deliver blood adequate for increased metabolic needs without elevation of filling pressure. Here we may have a systolic and/or diastolic dysfunction.
Etiologies include:
- Severe anemia
- Paget’s disease
- BeriBeri
- Thyrotoxicosis
- Large arteriovenous fistula
Signs and symptoms are similar to low output heart failure which is what makes this diagnosis slightly more challenging without proper testing.
Recommendations for high-output failure include:
- Salt restriction
- Diuretic use
- Treatment of underlying cause
Cor Pulmonale
Cor pulmonale is a right ventricular failure that occurs secondary to pulmonary disease (multiple etiologies), parenchymal and/or vascular, causing significant pulmonary hypertension.
Signs and symptoms include:
- Swelling
- Fatigue
- Palpitations
- Ascites
- Hepatosplenomegaly
- Edema
- Neck vein distension
- Right ventricular enlargement
- Right ventricular gallop(s)
- Tricuspid regurgitation
Further diagnostic tests that may be required:
- ECG with right ventricular hypertrophy
- Echocardiogram with right venticular enlargement and signs of pulmonary hypertension
Recommendations include:
- Salt restriction
- Diuretic use
- Treatment of underlying cause(s)