Heart Failure 2: Kind of Heart Failure

Failed heart Backward & Forward

For many years there is controversy about the clinical manifestation of the mechanism question arising in the failing heart. The concept of backward heart failure that the heart fails, one or other ventrikel failed to remove its contents, or fails to fill as normal. Consequently, pressure in the atrium and the vein behind the failed ventrikel increased, Retention of salt and water occurs as a consequence increase in pressure and vein systemic capillary pressure and consequently transudasi fluids to occur in the interstitial space. Instead, the heart fails to support hypothetical forward to maintain that the clinical manifestation of heart failure arises directly as a result not of sufficient blood to the arterial system. According to this concept, Retention of salt and water is a consequence of a decrease in kidney perfusi and reabsorbsi natrium tubuler maximal excessive and reabsorbsi tubuler distalis through excessive activation of renin-angiotensin system-aldosteron (Isselbacher et al. 2000).
Backward & Forward hypothetical is as follows: (Suryadipraja, 1996):
1. Backward Failure
When ventrikel fails to pump blood, the blood pressure and akan terbendung atrium and the veins behind up.
2. Forward Failure
Reduced blood flow (cardiac output) to the arterial system, so that reduction occurs perfusi on vital organs, including with all the consequences to the heart muscle.

Heart Failure Left and Right

Many of the clinical manifestation of heart failure arising as a result of excessive accumulation of fluid in the back of each one or both ventrikel. This liquid is usually located above (rear) chamber is the first specific heart exposed. For example, patients with left ventrikel the mechanical stress load (eg, aorta stenosis) or lower (for example, after Infark miokard) dispnea experience or ortopnea congestion as a result of tuberculosis, this condition is called as left heart failure. Conversely, if abnormalitas that underlie the right ventrikel the primary (eg, hypertension or valve stenosis secondary to tuberculosis tromboembolisme tuberculosis), symptoms arise due to congestion, such as tuberculosis ortopnea or dispnea paroksismal kongestif is less, edema, hepatomegali, and distensi vein systemic, as shown right heart failure (Isselbacher et al. 2000).
On the left heart failure occurred stive, out time aktivity a heavy, weak and tired quickly, awakened at night because of coughing and shortness of breath. While in the physical examination found the heart enlargement, takikardi (heart rate exceeded 100 times per minute), a fast and breathe in deep.
In the right heart failure symptoms develop body is weak, swelling feet, reduced appetite and flatulence. On physical examination found the right heart enlargement. Heart failure are on the manifestation of the combined kongestif going to fail left and right heart.

Heart Failure and Low-Output High-Output

The heart fails to show how the heart rainfall (high or low) as the cause of the occurrence of clinical manifestation of heart failure.
Low rainfall in the heart of any heart disease (congenital, hypertension, valve, coronary, kardiomiopati) can cause a low-output failure. While in diseases with high rainfall such as the heart on tirotoksikosis, beri-beri, paget's, anemia and vena-arterial fistula, heart failure occurs is called the high-output failure (Suryadipraja, 1996).

Heart Failure acute and chronic

Clinical manifestation of heart failure here only shows the time or the duration of heart failure occurs or takes place. In the event of a sudden, for example, in acute heart infark area, called acute heart failure (usually as acute left heart failure). While the disease-heart valve disease, heart failure or cardiomiopati due infark heart a long time, the occurrence of heart failure slowly or because the heart fails to survive long with a given treatment, called chronic heart failure (Suryadipraja, 1996).

Heart Failure Sistolik and Diastolik

I. Disfungsi Sistolik (Sitompul, 1996)
The implicit definition of heart failure is when the heart fails to occur as a result abnormalitas function sistolik, namely the inability of the blood called ventrikel as heart failure sistolik. This type of heart failure is the most classic and most famous day-to-day, it is interference ability inotropik miokard. So kontraktilitas ventrikel in pumping out, weakened cardiac output, and at the end of the sistolik akan ada ventrikel remaining in the blood that has not been issued. This will create volume and diastolik pressure diastolik up.
At the heart of the left failed to increase pressure diastolik forwarded to the retrograd then to the left atrium and the vein capillary tuberculosis. The increase in capillary pressure hidrostatik when tuberculosis is high enough (> 20mmHg), can cause fluid to transudasi in intertisium tuberculosis, and tuberculosis cause congestion complaints.
In the right heart failure, increased pressure diastolik forwarded to the right atrium, next arose veins dam and systemic signs of right heart failure. Increased ventrikel excessive afterload on the right most often caused by left heart failure, arterial hypertension due to a vein pulmonale that accompanies disfungsi ventrikel left.
Failed the pure right heart function which ventrikel normal left more rarely found. This often reflects increased afterload due ventrikel right parenkim tuberculosis disease or blood vessel tuberculosis. Heart failed like this is called cor pulmonale.

II. Disfungsi Diastolik
Meanwhile, when abnormalitas work on the heart diastolik phase, namely the ability of blood on the ventrikel (especially ventrikel left), for example, in the heart iskemia a sudden, hipertrofi konsentrik ventrikel left and kardiomiopati restriktif, heart failure that occurs is called heart failure diastolik. What happens is diastolik early relaxation interference, ventrikel wall stiffness, or both. So that when the phase diastolik, not akan maximum dilatasi, diastolik pressure was increasing, which in effect backward.
The most significant landmark in the heart failure is here: function sistolik ventrikel usually normal (especially with the measurement of ejection fraction, for example with the examination ekokardiografi (Suryadipraja, 1996). So on disfungsi diastolik, decrease symptoms of heart rainfall more rare. (Sitompul, 1996)