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Medical Pharmacology Chapter 46:  Congestive Heart Failure

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Clinical Manifestations and Physical Findings in Congestive Heart Failure


Cardiac Cachexia. Serious weight loss and cachexia may occur in chronic, severe congestive heart failure due to:

Increased circulating tumor necrosis factor

Increased metabolic rate need to support the increased effort of breathing

Anorexia, nausea, vomiting due to digitalis intoxication, congestive

Hepatomegaly, and abdominal fullness

Impairment of intestinal absorption due to intestinal venous congestion

Protein-losing enteropathy (rare)



Congestive Heart Failure

The fundamental abnormality in heart failure is embodied in:

  1. depression of the myocardial force-velocity relationship and

  2. length-active tension curves that result in impairment of myocardial contractility.

  •  When a normal heart transitions from the resting state (1) to exercise (2) a significant increase in ventricular performance occurs.

  • By contrast in the failing heart, the exercise-induced increases in ventricular performance are minimal (3' to 3).



  1. With disease progression increases in left ventricular preload causes pulmonary capillary pressure to increase

  2. This increase produces pulmonary congestion and dyspnea

  3. Systemic compensatory responses to heart failure include fluid retention and increased in left ventricular afterload.(see Figure, right)

Figures from "Harrison's Principles of Internal Medicine", Thirteenth Edition, pages 995 and 996.


Factors Influencing Cardiac performance and Output


Ventricular end-diastolic volume (preload)


Atrial Contraction

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