Left heart failure is caused by dysfunction of the left ventricle, resulting in insufficient blood flow to vital organs. It has three stages: Stage I involves redistribution of blood flow from the lower to upper lung lobes due to increased pulmonary capillary pressure. Radiology shows cephalization and cardiomegaly. Stage II involves fluid leakage into the interstitial spaces seen as thickened septal lines, ground glass opacities, and bilateral pleural effusions. Stage III is severe with fluid in the alveoli seen as consolidations, air bronchograms, and pleural effusions. Pulmonary edema can be cardiogenic or non-cardiogenic like ARDS.

1. Left heart failure

2. Definisi: Disfungsi ventrikel kiri yang menyebabkan insufisiensi pengaliran
darah ke seluruh organ vital tubuh
Etiologi:
• CAD
• Hipertensi
• Cardiomyopati
Patofisiologi: terjadi peningkatan tekanan kapiler pulmo  cairan berlebih
mengisi interstisial bronkovaskuler

3. Stage I : Redistribusi (12-18 mmHg)
• Patofis
↑ PCWP (pulmonary capillary wedge
pressure) mengakibatkan distensi
vessel yang telah mengalami perfusi
sebelumnya
• Adanya peningkatan resistensi
terhadap aliran ke base (arteri dan
vena ke lobus bawah dikompresi
oleh edema perivaskular)
peningkatan aliran ke apeks
(chepalisasi)
• Awalnya terjadi penyeimbangan aliran
darah kemudian redistribusi aliran dari
lobus bawah ke lobus atas
• Gambaran radiologi: cephalisasi,
Cardiomegaly, broad vascular pedicle

4. Stage II : Interstisial Oedema (18-25 mmHg)
- Patofis: bocornya cairan ke interstisial
peribronkial dan interlobular
- Gambaran radiologi:
Kerley B line
peribronchial cuffing
hazy contour vessel
penebalan fisura interlobular

5. Stage II : interstisial odem

6. • Penebalan septal lines karena
odem interstisial
• Subtle ground glass opacity in the
dependent part of the lungs (HU
difference of 100-150 between
the dependent and non-
dependent part of the lung).
• Bilateral pleural fluid

7. Stage III: alveolar odem (>25 mmHg)
Patofis: kebocoran lanjutan ke
interstisium, yang tidak bs
dikompensasi drainage limfatik 
sehingga bocor ke alveoli (alveolar
odem) dan ke ruang pleura (efusi
pleura)
Gambaran radiologi:
- Efusi pleura
- Air bronchogram
- Konsolidasi
- Bat-wing appearance

8. Stage III: alveolar odem
Pada rontgen dada dan pada
CT, edema bergantung pada
gravitasi dan perbedaan
densitas dapat diukur

9. Pulmonary odem
• 1. cardiogenic
• 2. non kardiogenik: ARDS
DD
• Diffuse pneumonia
• Massive aspiration
• Pulmonary hemmorhage

10. Pulmonary odem Left ventricular failure
In these settings, the hydrostatic pressure in the capillaries
exceeds the oncotic pressure and fluid is driven out of the
vasculature into the pulmonary interstitium and eventually
into the alveoli through the capillary endothelium and
alveolar epithelium.

11. • Chronic Left-Sided Heart Failure
• This condition is suggested by enlarged left-sided cardiac
chambers, with evidence of pulmonary venous hypertension
and with bilateral or a right-sided pleural effusion. (From 10% to
15% of patients with chronic left-sided heart failure have only a
left-sided pleural effusion, which, being unusual, should prompt
consideration of other causes of pleural disease.) Kerley B lines
are common.