Left heart failure can present with several symptoms: 1. Dyspnea that progresses from exertional to at rest due to decreased lung compliance, increased airway resistance, and respiratory muscle fatigue. 2. Orthopnea relieved by sitting up due to fluid redistribution increasing pulmonary capillary pressure and elevating the diaphragm. 3. Paroxysmal nocturnal dyspnea, episodes of dyspnea and coughing at night even when sitting up due to depressed respiratory center and reduced adrenal stimulation at night.

1. LEFT HEART FAILURE

2. MECHANISM

3. HOW DOES THE PATIENT
PRESENTS WITH?
1. DYSPNOEA-INITIALLY EXERTIONAL THEN PROGRESSING
TO DYSPNOEA AT REST
GRADE I → GRADE IV
MECH:

4. • ↓PULM.COMPLIANCE
• ↑ AIRWAY RESISTANCE
• RESPIRATORY MUSCLE &DIAPHRAGM FATIGUE

5. 2.ORTHOPNOEA
• DYSPNOEA OCCURING IN RECUMBENT POSITION
• RELIEVED BY SITTING UPRIGHT OR SLEEPING ON
ADDITIONAL PILLOWS
• NOCTURNAL COUGH MAY BE PRESENT
• MECH:-REDISTRIBUTION OF FLUID FROM SPLANCHNIC
CIRCULATION &LOWER EXTREMITIES IN TO CENTRAL
CIRCULATION→
INCREASE IN PULM. CAPILLARY PRESSURE
- ELEVATION OF DIAPHRAGM

6. 3.PAROXYSMAL NOCTURNAL DYSPNOEA
• A/C EPISODES OF DYSPNOEA &COUGHING OCCURING AT NIGHT
WHICH AWAKEN THE PATIENT FROM BED 1-3 HRS AFTER HE
RETIRES
• PERSISTS EVEN AFTER SITTING UPRIGHT
• MECH:-DEPRESSION OF RESP. CENTRE DURING SLEEP
-REDUCED ADRENERGIC STIMULATION OF MYOCARDIUM AT
NIGHT

7. 4.CARDIAC ASTHMA
PULM.EDEMA &BRONCHIAL WALL EDEMA
↓
WHEEZING
5.A/C PULM. EDEMA
-MARKED ELEVATION OF PULM. CAPILLARY PRESS.
↓
ALVEOLAR EDEMA
↓
COUGH WITH COPIOUS PINKISH FROTHY SPUTUM
&BILATERAL CREPITATION

8. 6.CHEYNE STOKES RESPIRATION
• PERIODIC BREATHING WITH ALTERNATE PERIODS OF
APNOEA & HYPERVENTILATION
• MECH:-DIMINISHED SENSITIVITY OF RESP. CENTRE TO
ARTERIAL PCO2
7.CENTRAL & PERIFERAL CYANOSIS
8.FATIGUE
9.MENTAL CONFUSION

9. 3. CARDINAL SIGNS OF LVF
1. GALLOP RHYTHM
S1+S2+S3 OR S1+S2+S4----TRIPLE RHYTHM
S1+S2+S3+S4-----QUADRUPLE RHYTHM
IF S3 &S4 MERGE ----SUMMATION GALLOP
2. FINE BASAL CREPITATIONS
3. PULSUS ALTERANS—WHEN THE ALTERNATE PULSES ARE
WEAK.[LOW VOL.] BUT RHYTHM IS NORMAL
-BETTER FELT IN RADIAL A
-HEALTHY &DEGENERATED MUSCLE FIBRES PRODUCING
NORMAL &WEAK BEAT RESPECTIVELY[DEFECTIVE
ELECTROMECHANICAL COUPLING]
-POOR PROGNOSIS

10. • BP: ↓PULSE PRESSURE DUE TO REDUCED STROKE VOL.
HYPOTENTION
DBP SLIGHTLY RAISED
• IF CARDIOMEGALY –APEX SHIFTED OUTWARDS &
DOWNWARDS

11. CHEST X–RAY FINDINGS
• PROMINANT UPPER LOBE VEINS
• KERLEY B LINES – HORIZONTAL LINES IN COSTOPHRENIC
ANGLES- THICKENED INTERLOBULAR SEPTA &
ENGORGED PERIPHERAL LYMPHATICS IN LOWER LOBE
• BAT’S WING-INCREASED BRONCHOVASCULAR
MARKINGS[INVERTED MOUSTACHE SIGN]
• CARDIOMEGALY
• PLEURAL EFFUSION