Understanding Heart Failure and Meningeal Syndrome
Heart Failure
Heart failure is a condition where the circulatory system fails to deliver sufficient oxygenated blood to the tissues. It is a common cause of hospitalization and death, with incidence increasing with age.
Mechanisms of Heart Failure
Ventricular dysfunction, measured by echocardiography, can lead to heart failure through:
A) Systolic Dysfunction:
The heart’s ability to pump blood effectively is compromised, typically with a decreased ventricular ejection fraction and increased heart volume (cardiomegaly).
B) Diastolic Dysfunction:
Ventricular filling is hindered due to decreased compliance, often without cardiomegaly but with elevated ventricular filling pressures.
Causes of Heart Failure
- Cardiomyopathy
- Coronary insufficiency
- Valve disease
- Constrictive pericarditis
- Chronic arrhythmias
- Congenital heart disease with shunts
- Hypertension
Classification of Heart Failure
Based on Duration of Symptoms:
1. Acute:
Sudden onset, often due to myocardial infarction or myocarditis.
2. Chronic:
Develops gradually and insidiously.
Based on Semiology:
1. Left Heart Failure:
Symptoms:
- Dyspnea (shortness of breath)
- Orthopnea (difficulty breathing when lying down)
- Cardiac asthma (waking up gasping for air)
Signs:
- Cold, clammy skin
- Tachypnea and tachycardia
- Systolic murmur
- Hypotension
- Pulmonary congestion and edema
- Oliguria and nocturia
- Gallop rhythm
- Pleural effusion
- Mental and neurological disorders
Pulmonary Edema:
A severe manifestation of left heart failure with symptoms like cough, progressive dyspnea, anxiety, paleness, cyanosis, and pink sputum.
NYHA Classification:
- Grade 1: No symptoms with regular activity.
- Grade 2: Symptoms with strenuous activity.
- Grade 3: Symptoms with minimal activity.
- Grade 4: Symptoms at rest.
Common Causes of Decompensated Heart Failure:
- Infection
- Anemia
- Uncontrolled hypertension
- Hyperthyroidism
- Pregnancy
- Arrhythmias
- Pulmonary embolism
- Myocardial infarction
- Infective endocarditis
- Excessive physical activity
- Treatment non-compliance
2. Right Heart Failure:
Often associated with chronic obstructive pulmonary disease (COPD) and called Cor pulmonale. Usually a consequence of left heart failure.
Symptoms:
- Fatigue
- Malaise
- Abdominal discomfort
- Anorexia
Signs:
- Distal cyanosis
- Jugular venous distention
- Tricuspid regurgitation
- Pulmonary hypertension
- Hepatomegaly
- Pleural effusion
- Jaundice
- Ascites
- Edema in lower extremities and abdomen (anasarca)
3. Global or Congestive Heart Failure:
A combination of left and right heart failure.
4. High-Output Heart Failure:
Characterized by a hyperkinetic circulatory state with symptoms like dyspnea, palpitations, and tachycardia. Occurs in conditions like pregnancy, anemia, and hyperthyroidism.
Meningeal Syndrome
Meningeal syndrome refers to irritation or inflammation of the meninges, often due to meningitis caused by bacteria, blood, or neoplastic infiltration.
Signs and Symptoms of Meningeal Syndrome
1. Headache:
Intense, continuous headache, often accompanied by vomiting and bradycardia.
2. Stiff Neck:
Difficulty flexing the neck due to muscle contracture.
3. Encephalitic Signs:
Positive Brudzinski and Kernig’s signs, indicating meningeal irritation.
4. Other Signs:
- Hypertonia (muscle rigidity)
- Impaired consciousness
Diagnosis
Diagnosis involves a lumbar puncture to analyze cerebrospinal fluid. A CT scan may be performed beforehand to rule out intracranial hypertension or brain tumors.