Cardiac insufficiency causes
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Causes of Cardiac Insufficiency
Cardiac insufficiency, also known as heart failure, is a complex condition with multiple underlying causes. This article synthesizes findings from various research studies to provide a comprehensive overview of the primary factors contributing to cardiac insufficiency.
Structural and Histochemical Changes in the Myocardium
Myocardial Hypertrophy and Fibrosis
Chronic cardiac insufficiency often involves significant structural changes in the myocardium. Hypertrophied hearts, even without insufficiency, show increased width, volume, and dry weight of cardiac muscle fibers. However, in cases of myocardial hypertrophy with insufficiency, there is a notable decrease in DNA synthesis and an increase in connective tissue cells, which reduces the number of functional cardiac muscle cells. This imbalance leads to a lack of contractile proteins and increased fibrosis, contributing to cardiac insufficiency.
Ultrastructural Disturbances
Disturbances in the ultrastructure of the heart muscle, such as a decrease in the number of myofilaments and myofibrils, can lead to acute cardiac insufficiency. These changes may result from factors like starvation or potassium depletion. Additionally, mitochondrial swelling due to intracellular ionic changes and necrosis of individual muscle cells are significant contributors to cardiac insufficiency. The increase in connective tissue relative to muscle tissue further exacerbates the condition.
Pathophysiological Mechanisms
Chronic Pressure Overload
Chronic pressure overload, as seen in conditions like hypertension, leads to structural dilatation of the heart. This dilatation often precedes the symptoms of heart failure. The impairment of myocardial contractility, diffuse fibrosis, and the adaptive transformation of myocardium towards a slower muscle type are key factors in the manifestation of cardiac insufficiency under chronic pressure overload.
Coronary Insufficiency
Coronary insufficiency, primarily due to inadequate coronary blood flow, is a major cause of cardiac insufficiency. Atherosclerotic changes in the coronary arteries can progress insidiously, leading to infarction and subsequent heart failure. Acute coronary insufficiency is a common cause of sudden death, often associated with ventricular fibrillation or tachycardia.
Hypertension and Cardiac Insufficiency
Coronary Arterial Involvement
In hypertensive patients, significant coronary arterial involvement, such as sclerosis or thrombosis, is a common finding in those who die with symptoms of myocardial insufficiency. The extent of coronary artery disease correlates with the severity of myocardial changes, contributing to heart failure.
Postinfarction Cardiac Insufficiency
Postinfarction cardiac insufficiency is primarily due to a reduction in the contractile function of the left ventricular myocardium. Factors such as heart mitralization, tachysystolic ventricular fibrillation, and repeated infarctions aggravate the condition, leading to hypertension in the general circulation system.
Inflammation and Renal Disease
Hemodialysis and Cardiovascular Complications
Chronic kidney disease (CKD) and cardiac insufficiency often coexist, particularly in patients on hemodialysis (HD). Poor renal function in these patients indicates poorer cardiac mechanics and increased risk of adverse cardiovascular events. Inflammation plays a crucial role in the development of cardiovascular complications in CKD patients, highlighting the need for anti-inflammatory treatments to improve prognosis.
Conclusion
Cardiac insufficiency is a multifaceted condition with various underlying causes, including structural changes in the myocardium, chronic pressure overload, coronary insufficiency, hypertension, and inflammation associated with renal disease. Understanding these factors is crucial for developing effective treatment strategies and improving patient outcomes.
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