my father has heart disease and in the past month he has been getting worse he has flu like symptoms all the time and is often laid up in bed with it, he has swelling in his legs,
he is under the care of a heart specialist who has said he has damaged lungs and is now showing signs of liver damage,
i was wondering if anyone could explain to me why it affects his lungs
thanks. Congestive hepatopathy is diffuse venous congestion within the liver that results from right-sided heart failure (usually due to a cardiomyopathy, tricuspid regurgitation, mitral insufficiency, cor pulmonale, or constrictive pericarditis).
In RV failure, systemic venous pressure increases, causing fluid extravasation and consequent edema, primarily in dependent tissues (feet and ankles of ambulatory patients) and abdominal viscera. The liver is affected most, but stomach and intestine also become congested; fluid accumulation in the peritoneal cavity (ascites) can occur. RV failure commonly causes moderate hepatic dysfunction, with usually modest increases in conjugated and unconjugated bilirubin, PT, and hepatic enzymes (eg, alkaline phosphatase, AST, ALT). The impaired liver breaks down less aldosterone, further contributing to fluid accumulation. Chronic venous congestion in the viscera can cause anorexia, malabsorption and protein-losing enteropathy (characterized by diarrhea and marked hypoalbuminemia), chronic GI blood loss, and rarely ischemic bowel infarction.
With hepatic congestion, the liver may be palpably enlarged or tender, and hepatojugular or abdominal-jugular reflux may be detected. Precordial palpation may detect the left parasternal lift of RV enlargement, and auscultation may detect the murmur of tricuspid regurgitation or the RV S3 along the left sternal border.
Please note that I am not a medical professional. Without knowing his history it is impossible to guess accurately what the causes are. Best to talk to his doctor. Did he smoke? Is/was he over weight? Does he have high blood pressure (this can cause strain on kidneys)?
The body is an incredibly complex organism in which all the parts work together... nothing is separate. So when one part is not working properly (i.e., is diseased) it will impact lots of other parts.
Given your dad's heart disease, you may find this site useful in both giving you and him information as well as tips on how to deal with various aspects of what is happening http://www.smart-heart-living.com/index....
Hope this helped. Good luck to you and your dad. Hi CatJam,
Before answering this question we must review a little bit of heart anatomy and cardiac physiology. Not to worry it is not much.
Heart Anatomy:
Draw a square on a piece of paper (Interactive lesson haha). Now in the middle of this square draw a plus sign (AKA from the center draw one line horizontally, and another line vertically at the center). Ok you will notice that you have 4 squares. Going from top left that would be right atrium. Before you ask how left could be right atrium simple, you are looking at the heart straight on. Think of it as if you were the physician looking at your fathers chest, as if you were looking directly at your father. Thus left is right and vice versa. Back to anatomy.
Top Left Square = Right Atrium
Top Right Square = Left Atrium
Bottom Left Square = Right Ventricle
Bottom Right Square = Left Ventricle
(I cannot draw what I want to show you properly, but I hope you get the idea)
___________________________
| Right Atrium | Left Atrium |
|__________________________|
| Right Ventricle | Left Ventricle |
|__________________________|
Ok so there is our makeshift very simplified heart.
Now for some physiology:
Remember that the heart is basically a pump. The way this pump works is that the left side pumps blood that just came from the lungs (oxygenated blood enters the left atrium) which will pass to the left ventricle which is then pumped with a force of 120mmHg (systolic pressure) to the aorta which then goes to the rest of our body. The right side on the other hand recieved blood (deoxygenated, keep in mind this deoxygated blood still has some oxygen in it, very little though) which enters the Right atrium from the vena cava (There is Superia and Inferior vena cava). So to repeat, right side of heart recieves blood into the atrium, which will be passed to right ventricle which it pumps to the lungs, this in turn will oxygenate the blood. This bright red oxygenated blood will now enter the left atrium and leave through the left ventricle to be passed in our entire body.
Now considering what you have told me, your father most likely has one of two heart diseases which can be due to many reasons. My assumption is what physicians typically call CHF (Congestive Heart Failure). Now do not get afraid. Basically all this means is that the heart is failing to work properly as a pump. Now to explain a little bit about this disease.
CHF: Almost all heart diseases eventually lead to CHF if not treated properly. One of systemic reasons (whole body, whole system), is hypertension (high blood pressure). Back to some physiology again. Imagine that left ventricle trying to pump blood. To pump blood to the rest of the body it must exert some kind of force (think of it as strength). So normally a good force is 120mmHg. Now imagine that the aortas lumen (space of the tube, remember that this is where the blood from left ventricle is pumped into) is a little small. There are many reasons why this space could be small, but one of the most common is atherosclerosis (wall thickening). This aorta has also lost some elasticity and does not expand as it once did. So now the poor heart must pump extra hard because the space is smaller. For example, imagine you have to blow air through a straw. What would you rather have, a large tube or a tiny tube? Large tube right? It is easier to blow air throw it. Another example would be a balloon. What kind of balloon would you like to have to blow full of air, a normal balloon you can buy in the store that is nice and elastic or a hot water bottle (those thick usually reddish/brown rubber bottles that people use when they have a stomach ache etc. Back to the heart. The poor heart has been trying to get stronger and stronger, and considering that your heart is a type of muscle (cardiac muscle), it will start to grow in size (hypertrophy). The problem with the heart in comparison to other muscle that we have such as arms is that it only grows in size and not the number of cells. So now imagine these heart cells getting bigger and bigger. But wait there is a problem, it only gets bigger, there is no new formation of new cells to help out with all this work. End result is that the walls of the heart begin to thin out. This will eventually result in weak cells. It sounds strange but it makes perfect sense. The cells grow and grow in size, expanding but just like that balloon, the walls start to thin out. We call this cardiomegaly (megaly = large, so large heart). So as the walls thin out it loses strength. Another example. One day fill a balloon with air (or water), you will see that the balloon starts to change colours as the walls are thinned out.
Before continuing, remember that blood is made up of many things, namely red blood cells and plasma which is itself mostly water and some proteins (mainly albumin, like what egg whites are made of). This is important because this water will start to escape the blood.
So now to actually answer your question.
So for any number reasons, one of the most common being hypertension (high blood pressure), your fathers heart began to grow in size (cardiomegaly) until eventually it actually became weak. But the rest of your body does not care, it keeps sending blood to the right side of the heart. Now imagine that you keep sending blood to something that cannot pump it out fast enough, the blood will start to pool (collect, AKA congest). This pooled blood begins to release water due to increased pressure in the blood vessels (Arteries/veins). Now imagine we are at the lungs. The lungs are trying to drain their blood through the pulmonary veins into the left atrium, but they cannot drain either and blood starts to collect there as well and they start to flood with water (pulmonary edema). Edema basically means that water is collecting outside of the. Since the lungs are congested (filling with water), they have a hard time to function as well. Harder to exchange carbon dioxide for oxygen. Just imagine that you were trying to breath under water or with water in your lungs. This also leads to pulomanry infections etc. We will move on. So imagine your fathers legs. They are getting filled with blood because the pump (heart) is not able to properly function. So your fathers legs start to swell. Lets keep moving along your fathers cardiopulmonary system. So this blood starts to travel back to the heart from the feet. It goes up and up finally getting into the vena cava. Well the liver is connected through a vein called the portal vein to the vena cava (inferior vena cava). But wait there is so much blood that the portal vein cannot drain properly (Portan Vein Hypertension) so it starts to flood the liver and it gets congested. When this happens the liver cells (hepatocytes) begin to swell and become damaged. So we keep going up the venous system. If you look closely at your father, you might notice that there is something pumping near his neck (more common right side). The reason for this is that the blood from the head is drained through the jugular veins into the vena cava. Remember though that the poor heart is all congested (flooded) with blood and thus it cannot drain properly either. Well that pumping you may or may not see is called JVD (Jugular Vein Distension). So why is the right side of the heart congested? Same reason the left side is congested. As a general rule high blood pressure causes the left side to grow first, as it grows and starts to fail as a pump leaving more blood in the chamber then it should because of weakening heart muscle walls. As mentioned earlier, this leads to the lungs becoming congested. This leads to pulmonary hypertension. Since the right side of the heart is connected to the lungs (remember it sends blood to lungs so that this blood may get oxygen). Well now the right side must also grow in size so that it can overcome the high pressure found in the lungs blood vessels. Just like the left side of our heart, it grows and its walls weaken. Global CHF is the term used to describe that the whole heart is failing.
When the liver begins to fail due to CHF, this eventually affect the brain. The reason for this is that the liver has many special functions. One of the most important is that it chemically filters our blood. Most people call the liver the humans chemist and it really is. Well something that the liver must take care of is the urea cycle. Basically urea is a poison in our blood and we need to get rid of it namely the amonia component. Amonia will go to our brain and start to damage it. But do not get too afraid, there are treatments for this including changes in diet (less protein), enemas, lactulose, L-ornithine-L-aspartate etc.
So what does this all mean to your father. Well simply put your family must do their best to support him during this disease which has no cure. It requires changes in diet, medications, very strict control of high blood pressure etc. He must take the medications as prescribed etc.
I wish you and your family my best wishes. Keep your hopes up and your chin up high. With proper treatment he should improve and start to feel better.
Daniel
R1 Medical Resident |
