HEART FAILURE (हृद्दौर्बल्य) - 4
For the next several days, I busied myself understanding the details of the heart failure (हृद्दौर्बल्य).
Whatever
time was left after attending the outdoor and indoor, I sacredly used
in studying, understanding, discussing, and analysing various aspects of
the heart failure.
For a
proper understanding of the heart failure, I referred a large number of
books and journals on cardiology, medicine, pathology, and
pharmacology. In addition, once again I had to refer Prof. Arthur C.
Guyton's Textbook of Medical Physiology for a better understanding of
the problem.
I noticed
one thing. Despite all its complexities, understanding the heart failure
(हृद्दौर्बल्य) made an extremely enjoyable experience.
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As
I dived deeper and deeper into the depths of the subject, the extent of
the enjoyment I derived out of it, multiplied manifold.
Underlying abnormalities in heart failure:
Happily, my hard efforts to understand the problem with as much clarity as possible, started bearing fruit.
There
was no doubt that heart was a matchless pump in the world. Yet, to
understand it's failure, I tried to look at it like any other mechanical
pump.
I realized that
the mechanical pumps fail for two reasons - either the pump gets weaker
or it is made to work more than its capacity.
Surprisingly, I soon realized that both of these two factors appeared to operate in case of human heart failure, too.
I
found that almost all the authors held a unanimous approach about the
heart failure. Everyone seemed to believe that the heart failed -
(i) Either, when some sort of weakness occurred in the myocardium; Or
(ii) The work load on the heart increased.
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A
deeper insight into the problem revealed that lot many cardiac and
extracardiac abnormalities were actually responsible for the above twin
mechanisms. For instance -
- Lowered pumping capacity of the heart (lowered myocardial contractility) because of many factors;
- Any obstruction lying in the path of the blood leaving the atria or the ventricles;
- Any obstruction lying in the path of the blood entering the atria or the ventricles;
- Increased load on the heart chambers for pumping more than the normal quantity of the blood;
- The heart chambers not relaxing fully during diastole; and
- Presence of tachycardia or bradycardia (heart block).
Now came the time to view the above abnormalities in greater detail.
At the outset, I focused on the factors that lowered the pumping capacity of the heart (myocardial contractility).
I. Lowered myocardial contractility
The question was, what were the factors that precisely lowered the force of contraction of the heart muscle.
To this end, following factors came to the fore -
1. Ischemia (अल्प-रक्तता ):
Almost
every author emphasised that the most common pathology that weakened
the heart muscle and lowered it's force of contraction was its reduced
blood supply.
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When
the reduction in blood supply developed slowly, over the years, the
heart muscle grew increasingly weaker. Consequently, the areas of the
ischemic myocardium showed dyskinesia (lowered movement) resulting in
what was called as chronic heart failure.
On
the other hand, when the blood supply stopped suddenly due to a sudden
occlusion of a coronary artery, it made the corresponding area of thr
heart muscle dead (acute myocardial infarction), resulting in suddenly
lowered force of contraction of the heart muscle. As the infarcted
myocardium could not contract (akinesia), this obviously led to acute
heart failure.
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In both the situations, the force of contraction of the cardiac musculature was bound to be lowered.
2. Myocarditis:
The
other abnormality that could lead to lowered force of contraction of
the heart muscle was the inflammation of the heart muscle (Myocarditis).
It
was said that several factors could result in inflammation in the
cardiac musculature. These included - Viral infections, bacterial
infections, toxins, immune disorders, etc.
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I
knew that if inflammation developed in any of the organs on the body -
loss of function - was one of its five cardinal feature.
The
same applied to the heart muscle too. As the inflamed heart muscle
found it difficult to contract properly, the force of contraction of the
heart was bound to get affected leading to pump failure.
In such a case, there sets in progressive dilatation of the heart with the consequent global dysfunction.
3. Cardiomyopathy:
The
third underlying cause for the lowered contractility of the heart
muscle was the cardiomyopathy, that in turn resulted from various
infections, toxins, immune disorders, genetic disorders etc.
Like myocarditis, cardiomyopathy too
resulted in progressive dilatation of the heart with the consequent global dysfunction.
Contd...
डाॅ.वसिष्ठ
Dr. Sunil Vasishth
M. + 91-9419205439
Email : drvasishthsunil@gmail.com
Website : www.drvasishths.com
Dr. Sunil Vasishth
M. + 91-9419205439
Email : drvasishthsunil@gmail.com
Website : www.drvasishths.com
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