Questions to prepare for classes and examination
• Definition, general causes and classification of heart failure.
• Myocardial and nonmyocardial cardiac insufficiency.
• Adaptive reactions during acute and chronic heart failure: Frank-Starling mechanism, myocardial hypertrophy, redistribution of cardiac output, salt and water retention, activation of the sympathetic system.
• Pathogenesis of the myocardium decompensation during hypertrophy.
• Structural and hemodynamic abnormalities in heart failure.
• Clinical features of heart failure: the syndromes of cardiac edema and cachexia.
N 93*
A 40-year-old patient Z. suffers from tuberculosis. He has come to see his physician with complaints of dyspnea, pains in the right upper quadrant, and subfebrile fever. These symptoms emerged four weeks ago and were progressing. On examination: the face is pale and rounded orthopnea is evident (the patient is sitting upright with his hands resting upon chair, this posture is necessary to ease breathing); the area of cardiac dullness is increased to the left and to the right by 2 cm, heart rate is 100 per minute, blood pressure is 90/60 mm Hg. On auscultation: muffled heart sounds, crackles at the base of the lungs. Breathing rate is 26 per minute. The neck veins are distended; the liver is tender on palpation and extends 3 cm below the costal margin; there is trace pretibial and feet edema. An X-ray examination of the chest shows the globular shadow of the heart.
Questions
• Does the patient have signs of cardiac insufficiency? Substantiate your answer.
• What additional tests are required to specify the form of the heart pathology in this case?
• Make a conclusion about the form of cardiac insufficiency in this patient.