Physiologie de la défaillance cardiaque (DC)
Daniel Sidi
Necker-Enfants Malades - M3C Université Paris V
Seminaire 2010
P
V
P
V P
V
P
V
Contractilité Compliance
Post charge Pré charge
P
V P
Contractilité V Compliance
Vasodilatateur Diurétique
P
V
VCS VCI
Ao
VP
AP VG
OG
VD
OD
P
V 80
12
20
4 100/60 80
100/0 12
8
∆P = 8
RVP/RVS = 1/10 16
8
20/0 4
2
P
V
VCS VCI
Ao
VG
OG
VD
OD
P
V 80
30
45
12 100/60 80
100/0 30
20
∆P = 25 RVP/RVS = 1/5
VP
AP 65/30 45 20
65/0 12
7
Insuffisance ventriculaire gauche Post charge VD
VCS VCI
Ao
VG
OG
VD
OD
P
V 90/50 70
90/0 8
6
∆P = 100 RVP/RVS = 2
VP
AP 6
150/0 30
20
Insuffisance ventriculaire droite Pré charge VG 150/80 106
P
V 70
8
30 106
HTAP primitive
VCS VCI
Ao
VG
OG
VD
OD 100/60 80
100/0 30
20
∆P = 25 RVP/RVS = 1/5
VP
AP 65/30 45 20
65/0 12
Insuffisance ventriculaire gauche 7 Post charge VD
VCS VCI
Ao
VG
OG
VD
OD 90/50 70
90/0 8
6
∆P = 100 RVP/RVS = 2
VP
AP 6
150/0 30
20 Insuffisance ventriculaire droite Pré charge VG 150/80 106
VCS VCI
Ao
VP VG
OG
VD
OD 100/0 12
8 100/70 86
RVP/RVS = 1/8 = 10 40/10 18
60/0 10
6 Fallot fuite pulmonaire
P
V
VCS VCI
Ao
VP VG
OG
VD
OD
P
V 100/0 12
8 100/70 86
RVP/RVS = 1/8 = 10 40/10 18
60/0 10
6
Rigide Compliant
QP Ef IP A
C’est la pression diastolique qui est transmise
VCS VCI
Ao
VG
OG
P
V 100/0 12
8 100/70 86
RVP/RVS = 1/10 15
P
V DCPT
C’est la pression moyenne qui est transmise
0 20 100
12 4 PAP PTD VG PTD VD
Compliance VD Compliance VG
Ao
Elastance VD Elastance VG
Pr
V AP
shunt
Systole
20 100
20 100
2 8
Normal
AP Ao
25 100
40 100
8 8
CIA Qp/Qs = 2
AP Ao
VCS
VCI VP
VCS
VCI VP
70%
70%
100%
100%
85%
70%
100%
Diastole
10 60
0 - 4 0 - 12
2 8
Normal
AP Ao
20 100
0 - 12 0 - 12
8 8
CIA (Qp/QS = 2) VG VD normaux
AP Ao
VCS
VCI VP
VCS
VCI VP
2 3 70%
70%
100%
100%
85%
70%
100%
CIA avec défaillance VG CIA (Qp/QS = 2)
VG VD normaux
20 100
0 - 12 0 - 12
8 8
AP Ao
VCS
VCI VP
1 Qs 3 85%
70%
100% 20 60
0 - 20 0 - 20
12 12
AP Ao
VCS
VCI VP
92%
70%
100%
100%
3 Qs
12 Diastole
CIA avec défaillance VD HTAP primitive CIA (Qp/QS = 2)
VG VD normaux
20 100
0 - 12 0 - 12
8 8
AP Ao
VCS
VCI VP
1 Qs 3 85%
70%
100% 80 60
0 - 12 0 - 12
8 8
AP Ao
VCS
VCI VP
55%
55%
85%
100%
1/2 Qs
8 Diastole
Défaillance VD HTAP primitive avec CIA
60
120/0 - 12 100/0 - 12
8 8
AP Ao
VCS
VCI VP
55%
55%
85%
100%
1/2 Qs
8
60
150/0 - 30 70/0 - 8
20 6
AP Ao
VCS
VCI VP
50%
50%
100%
100%
20
Défaillance VD HTAP primitive sans CIA
120/60 80 100/60 80 150/80 110 70/50 60
Systole et Diastole
Fœtus ASD + PDA P
PA = Ao40
LA = RA4 LV RV
R
L L R V
ESV EDV
Newborn without ASD closed ductusQP = QS Ao 60
RA 3
V LA 8
QS
PA 30 QP P
ESV EDV
P
RV LV
V P
RV LV
V
Fœtus = small LV Newborn = big RV
With ASD
Adults without ASD closed ductus
QP = QS Ao 100
RA 3
V LA 8
QS
PA 20 QP P
ESV EDV
L R
Newborn without ASD closed ductusQP = QS Ao 60
RA 3
V LA 8
QS
PA 30 QP P
ESV EDV
