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Body Fluids and Circulation PowerPoint Presentation

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Description : This presentation aims to get a basic idea about the body fluids and circulation. Emphasis is given to human circulatory system and their functional role. I hope that it build a basics idea regarding the concept so that a beginner student of medicine may get a clear cut idea about the body fluids and circulation

Tags : Body Fluids,Circulation

Published on : Dec 28, 2020 | Views : 2650 | Downloads : 4

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MSc, PhD, B. Ed, D.I.T, I.P.B.I, C-Gen, C- Prot, M.Biol(SL)
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Body Fluids and Circulation For the proper functioning of body Must be supplied nutrients, oxygen, and other essential substances Removed continuously waste or harmful substances To perform these functions an effective mechanism of transportation of these substances is essential. Different animals evolved different mechanism for these transportation. In sponges and coelenterates water circulate from their surroundings to the body cavity to exchange substances. Special fluids are present in more complex organisms In higher organisms including human blood is the circulating fluid. Lymph also helps in circulation In this chapter-Types of circulatory system, composition and properties of blood & lymph and mechanism of circulation.
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Types of Blood vascular system
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Open circulatory system Closed circulatory System
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Closed Types of Closed circulation Blood Circulation Double Single
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Single circulation The blood passes through the heart only once during each cycle. Deoxygenated blood pumped from the heart to gills. In the gills blood oxygenated. From the gills oxygenated blood supply to all the organs In the organ blood mixed with carbon dioxide and return back to the heart. Example: Fishes
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Double circulation Blood circulate through the heart twice during each cycle. Heart pumps deoxygenated blood to lungs In the lungs blood become oxygenated. Oxygenated blood from lungs pumps to heart. From the heart oxygenated blood supply to all the organs From the organs deoxygenated blood returns to heart From the heart deoxygenated blood again reach to lungs and repeat the cycle.
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Circulatory System In Human The human Circulatory system composed of Blood vascular system Lymphatic System Blood Vascular System It Consists of Blood Heart Blood Vessels BLOOD Blood is viscous, fluid connective tissue, red in colour, heavier than water, slightly alkaline in PH (7.4), salty in taste and derived from mesoderm. The different constituents of blood can be represented as
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BLOOD Plasma 55% Formed elements 44% 70% Water 7% Proteins 3% Other substance s Albumin Globulin Fibrinogen Nutrients Glucose, Amino acids Fatty acids Wastes Urea Uric acids Creatinine Regulators Hormones Enzymes Vitamins Anticoagulants Heparin Cholester ol & Antibodie s Gases CO2, O2,N2 RBCs WBCs Platelets Minerals like Ca,Na,Mg, HCO3, Cl etc
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Formed Elements Erythrocytes Most abundant of all the formed elements They are circular biconcave and enucleated (nucleated in Camel and Ilama) They have red coloured iron containing pigments called hemoglobin The average number of RBC in human male is 5.1-5.8 m/mm3 and in female 4.3-5.2 m/mm3 This is called total RBC count The average Lifespan of RBC is 120 days The formation of RBC is called erythropoiesis, formed from hemocytoblasts/ reticulocytes In foetus it occurs in liver and spleen, but in adults it is in red bone marrow. For hemopoiesis vit.B12, folic acids and haem proteins are needed The old RBCs are destroyed in liver and spleen (graveyard of RBCs) Polycythemia-increasing in RBCs, erythrocytopenia for decreasing Continue …………………………
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Hormone stimulate erythropoiesis-Erythropoietin Cytoplasm is devoid of mitochondria and other cell organelle and carbonic anhydrase Erythrocyte is responsible for the transportation of O2 and CO2 Hematocrit is the ratio of the volume of RBCs to total blood volume .
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Agranulocytes White blood corpuscles/Leucocytes They are colourless, nucleated and amoeboid cells larger than RBCs They can move out of the capillary walls by a process-diapedesis WBC count -5000-11000WBCs/mm3 Leucopenia-decrease in number(<4000)[ HIV, TB patients) Increase in number –Leukocytopenia (Infection, pregnancy) Uncontrolled increase in WBCs is called Blood cancer or leukemia WBCs are mainly related with defense mechanisms WBCs Granulocytes Neutrophils Basophils Eosinophil Lymphocytes Monocytes
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Granulocytes Cytoplasm is granular Also known as polymorpho nuclear leucocytes (PMN) They are formed from myeloid stem cells, once formed cannot divide. It forms 72 % of total WBCs Based on the staining property of the granules granulocytes are three types Neutrophils, basophils and eosinophils Neutrophils Granules stained with neutral stains It is about b70 % of total WBCs Nucleus is 2-7 lobed It is phagocytic Pus is the mixture of dead neutrophils, damaged tissues and dead microbes
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Basophils Eosinophils They contain lysosomal granules stained with acidic stains like eosin They are about 1-3 % of total WBCs Nucleus is bilobed They are phagocytic They have antihistaminic property They are involved in allergic condition They are also involved in detoxification by producing antitoxin Granules are stained with basic stains like methylene blue It is about 0.5-1 % of total WBCs Nucleus is twisted They are non-phagocytic It secrete heparin, histamine and serotonin They are involved in infection and allergic condition
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Agranulocytes 28% No Granules Formed from lymphoid stem cells and can divide Nucleus large and not lobed Lymphocytes Smallest of WBCs and have large nucleus 25-30 % of total WBCs There are two types-T and B lymphocytes They involved in immunity Monocytes Largest of all WBCs They form 3-5% of total WBCs Nucleus large and kidney shaped They are motile and give rise to macrophages They are phagocytic and destroy bacteria and dead or damaged tissues by phagocytosis
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Platelets/ Thrombocytes They are fragments produced from large cells called megakaryocytes ( Special cells in the bone marrow) Blood normally contain 1,50,000-3,50,000/mm3 They release substances involved in clotting or coagulation of blood Reduction in their number leading to disorder of blood coagulation and excess loss of blood. Platelets
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Blood Clotting or Coagulation of Blood Coagulation or clotting of Blood is the process of converting the liquid blood into a solid form. This process may be initiated by contact of blood with any rough surface (Intrinsic process) or with damaged tissue (Extrinsic process). Both the process involves interaction of various clotting factors by a cascade manner. Total 12 clotting factors from I to XII (Factor Vi is not in active use) Platelets and injured tissue release thromboplastin. Thromboplastin initiate the formation of an enzyme Prothrombinase. The prothrombinase in presence of calcium ions convert inactive prothrombin into active thrombin. The thrombin convert soluble fibrinogen to insoluble fibrin.
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The fibrin fibers enmeshes platelets , blood cells and plasma to form clot. The normal clotting time is 2-8 minute. The clot formed is known as coagulum. Blood Coagulation
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Blood Groups Blood Grouping ABO Rh ABO Blood grouping ABO blood grouping is based on the presence or absence two antigens name A and B on the surface of RBCs. Similarly the plasma of different individuals contain two different antibodies namely a and b.
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The distribution of antigens and antibodies in four groups of blood A,B,AB and O are given below This chart shows O blood can be donated to person with any other blood group and hence O blood group individuals are called universal donors. Person with AB blood group can accept blood from AB and other groups of blood and hence called universal recipients
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Rh Grouping Rh antigen similar to one present in Rhesus monkeys (hence Rh), is also observed on the surface of RBCs of majority (nearly 80 per cent) of humans. Such individuals are called Rh positive (Rh+ve) and those in whom this antigen is absent are called Rh negative (Rh-ve). An Rh-ve person, if exposed to Rh+ve blood, will form specific antibodies against the Rh antigens. Therefore, Rh group should also be matched before transfusions. A special case of Rh incompatibility (mismatching) has been observed between the Rh-ve blood of a pregnant mother with Rh+ve blood of the foetus. Rh antigens of the foetus do not get exposed to the Rh-ve blood of the mother in the first pregnancy as the two bloods are well separated by the placenta.
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However, during the delivery of the first child, there is a possibility of exposure of the maternal blood to small amounts of the Rh+ve blood from the foetus. In such cases, the mother starts preparing antibodies against Rh antigen in her blood. In case of her subsequent pregnancies, the Rh antibodies from the mother (Rh-ve) can leak into the blood of the foetus (Rh+ve) and destroy the foetal RBCs. This could be fatal to the foetus or could cause severe anaemia and jaundice to the baby. This condition is called erythroblastosis foetalis. This can be avoided by administering anti-Rh antibodies to the mother immediately after the delivery of the first child
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Lymph –Tissue fluid As the blood passes through the capillaries in tissues, some water along with many small water soluble substances move out into the spaces between the cells of tissues leaving the larger proteins and most of the formed elements in the blood vessels. This fluid released out is called the interstitial fluid or tissue fluid. It has the same mineral distribution as that in plasma. Exchange of nutrients, gases, etc., between the blood and the cells always occur through this fluid. An elaborate network of vessels called the lymphatic system collects this fluid and drains it back to the major veins.
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Lymphatic System The fluid present in the lymphatic system is called the lymph. Lymph is a colourless fluid containing specialized lymphocytes which are responsible for the immune responses of the body. Lymph is also an important carrier for nutrients, hormones, etc. Fats are absorbed through lymph in the lacteals present in the intestinal villi.
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Circulatory Pathway Diversity in heart All vertebrates possess a muscular chambered heart. Fishes have a 2-chambered heart with an atrium and a ventricle. Amphibians and the reptiles (except crocodiles) have a 3-chambered heart with two atria and a single ventricle. Crocodiles, birds and mammals possess a 4-chambered heart with two atria and two ventricles. In birds and mammals have complete double circulation
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In fishes have single circulation. In amphibians and reptiles, have incomplete double circulation. HUMAN HEART Heart is the main pumping organ of the circulatory system. Colour-Reddish brown, hollow, muscular organ The size of one’s fist. Weight is about 300gm in males and 250gm in females. It lies in mediastinum with broader at upper and conical at lower end (apex).
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Pericardium Heart is enclosed in a membranous sac called pericardium. Pericardium is formed of two main layers - outer fibrous and inner serous pericardium. Serous pericardium is further divisible into outer parietal and inner visceral layer. Parietal and visceral layers are separated by a pericardial space with pericardial fluid (about 50ml) which acts as a shock absorber and protects from mechanical injuries. It also keeps the heart moist and acts as lubricant.
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Heart wall and Pericardium
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The Heart Wall The heart is mesodermal in origin. Its wall is formed of three layers- outer epicardium, middle myocardium and inner endocardium. Epicardium is thin and formed of a single layer of flat squamous epithelium resting on basement membrane. Myocardium is the middle thick layer formed of cardiac muscles. Endocardium is a single thin layer formed of squamous epithelium. The epicardium and endocardium are protective in function whereas myocardium is responsible for contraction and relaxation of heart.
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External structure of human heart
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The human heart is four chambered. The two superior chambers are called atria (auricles) and inferior two are called ventricles. Externally, the atria are separated from ventricles by a transverse groove called coronary sulcus or atrioventricular groove. The two ventricles are externally separated from each other by two grooves, the anterior and posterior inter-ventricular sulci. Coronary arteries and coronary veins run through these sulci. Pulmonary trunk arising from right ventricle and aorta from left ventricle are present on anterior surface of heart.
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The pulmonary trunk bifurcates into right and left pulmonary arteries. Aorta (systemic aorta) is divisible into three regions as ascending aorta, systemic arch /aortic arch and descending aorta. The Ligamentum arteriosum joins pulmonary trunk and aortic arch. It is the remnant of an embryonic duct called ductus arteriosus. The aortic arch gives out three arteries viz. brachiocephalic (innominate) artery, left common carotid and left subclavian. The right atrium receives superior and inferior vena cava along its dorsal surface. Pulmonary veins open into left atrium along the dorsal surface of heart.
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Ventral View of Human Heart
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Internal Structure of Human Heart Atria : These are the thin-walled receiving chambers of heart. They are separated from each other by inter-auricular septum. Interauricular septum has an oval depression called fossa ovalis. It is a remnant of the embryonic aperture called foramen ovalis. Superior vena cava (precaval), inferior vena cava (postcaval) and coronary sinus open into the right atrium.
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Opening of the postcaval is guarded by a Eustachian valve while the Thebesian valve guards the opening of coronary sinus into right atrium. Four pulmonary veins open into the left atrium. These openings are without valves. Both the atria open into the ventricles of their respective sides by atrioventricular apertures. These openings are guarded by cuspid valves.
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The tricuspid valve is present in the right AV aperture and bicuspid valve (mitral valve) is present in the left AV aperture. All these heart valves help in maintaining a unidirectional flow of blood. They also avoid back flow of blood. Ventricles : These are inferior, thick-walled pumping chambers of the heart. The right and left ventricles are separated by an interventricular septum. Wall of the left ventricle is more muscular and about 3-times thicker than the right ventricle. Inner surface of the ventricles shows several ridges called columnae carnae or trabeculae carnae which divide the lumen of ventricle into small pockets or fissures.
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The lumen of ventricles also shows inelastic fibers called chordae tendinae. These attach the bicuspid and tricuspid valves to the ventricular wall (papillary muscles) and regulate their opening and closing. The right ventricle opens into the pulmonary aorta and left ventricle opens into the aorta. These openings are guarded by three semilunar valves each. These valves prevent the backward flow of blood into the ventricles.
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Pumping Action of Heart The heart acts as the main pumping organ of the circulatory system. The pumping action is brought about by a rhythmic contraction and relaxation of the cardiac muscles or heart muscles. Contraction of heart muscles is systole and relaxation of heart muscles is diastole. A single systole followed by diastole makes one heart beat. The heart beats 70 to 72 times per minute. This is called heart rate. During each heart beat ventricles pump about 70 ml of blood this is called stroke volume. It means heart pumps about 72 (heart rate) x 70 ml (stroke volume) = 5040 ml ≈ 5 liters of blood per minute this is called cardiac output.
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Conducting Tissues of Heart The human heart is myogenic i.e. the heart is capable of generating a cardiac contraction independent of nervous input. It also shows auto rhythmicity i.e. it can generate its own rhythm by specialized muscles. A specialized cardiac musculature called the nodal tissue is distributed in the heart. A part of this nodal tissue is present in the upper right corner of the right atrium.
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It is called SA Node or Sinoatrial node. It lies at the base of opening of superior vena cava. Another mass of nodal tissue, the modified muscular fibers also called autorhythmic fibers (conducting tissue) control the beating rate of heart. Conducting (nodal) tissue consists of SA node, AV node, bundle of His and Purkinje fibers. Conducting system of the heart SA node (sinu-atrial node) is present in the right atrium. It acts as pacemaker of heart because it has the power of generating a new wave of contraction and making the pace of contraction.
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SA node passes the contraction to the left ventricle and also to the AV node. AV node (atrio-ventricular node) is present in the right atrial wall near the base of interatrial septum. It acts as pace setter of heart. Bundle of His/ Tawara branches start from AV node and pass through interventricular septum. Bundle of His forms two branches, the right and left bundles, one for each ventricle These branches form network in ventricular walls and these are called Purkinje fibers. Bundle of His and Purkinje fibers spread impulses in ventricles. As a result both the ventricles contract simultaneously.
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Working mechanism of human heart Cardiac Cycle Human heart alternately contracts and relaxes. Contraction is called systole and relaxation is called diastole. Atria and ventricles contract alternately. Consecutive systole and diastole constitutes a single heartbeat or cardiac cycle. It is completed in 0.8 sec. On an average, 72 beats are completed in one minute in an adult, at rest. Right atrium receives deoxygenated blood and left atrium receives oxygenated blood. When both the atria are completely filled with blood, pressure is exerted on the wall. In response to this pressure, SA node gets excited and generates cardiac impulse. Due to this, cardiac muscles in the atrial wall contract causing atrial systole. During atrial systole, blood is pumped into ventricles.
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Atrial systole (AS) Blood is prevented from going back to the veins and coronary sinus by Eustachian and Thebesian valve respectively. After completing systole the atria go into diastole. In normal conditions, atrial systole is for 0.1 sec. and atrial diastole (AD) is for 0.7 sec. Ventricular systole (VS) The impulse which started from SA node now reaches the AV node and it gets excited. AV node sends impulses to bundle of His and from bundle of His to Purkinje fibers. Purkinje fibers spread impulses all over the wall of ventricles.
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Due to this, ventricular wall contracts causing ventricular systole. During ventricular systole, right ventricle pumps deoxygenated blood into pulmonary trunk and left ventricle pumps oxygenated blood into aorta. During ventricular systole the cuspid valves close both the atrioventricular apertures preventing blood flow into atria (lubb sound is heard). In normal conditions, ventricular systole lasts for 0.3 sec. and ventricular diastole (VD) lasts for 0.5 sec.
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During ventricular diastole, semilunar valves are closed, preventing backflow of blood from pulmonary trunk and systemic aorta into ventricles (dub sound is heard). For about 0.4 second, both atria and ventricles are in diastole. When all the chambers of heart are in diastole, this condition is called joint diastole or complete diastole. Thus, duration of one cardiac cycle is 0.8 sec.
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Right side of heart contains deoxygenated and left contains oxygenated blood. Total volume of blood pumped during one ventricular systole is called stroke volume (SV) and it is it approximately 70 ml. Cardiac output (CO) It is the volume of blood pumped out per min. For a normal adult human being it is calculated as follows : (CO) = SV × HR = 70 × 72 = 5040 ml/min
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Blood vessels Arteries Veins Capillaries Arteries These blood vessels carry blood from heart to various parts/organs of the body. They normally carry oxygenated blood to all parts of the body (except the pulmonary artery which carries deoxygenated blood). They are usually situated deep in the body except a few like the radial, brachial, femoral, etc. Which are superficially located.
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Wall of Artery Tunica Externa Tunica Media Tunic Interna Tunic Externa(Tunic Adventia) -thick, tough layer of collagen fibers. Tunic Media-smooth muscles and elastic fibers, makes the arterial wall pulsatile. Tunic Interna (Intima)-a single layer of flat compact endothelial cells surrounding the lumen. The angular margin around the lumen shows tessellations. Arterial lumen is devoid of valves and blood flows through it rapidly and with high pressure.
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Veins Veins are thin walled, mostly superficial vessels which carry blood from the organs towards the heart. The capillaries around the various organs join to form the veins. Except for the pulmonary veins or other veins of the body carry deoxygenated blood towards the heart. Veins also show the three layers, the tunica externa, tunica media and tunica interna. However, the tunica media is comparatively thinner and their lumen is wide and narrow. Internal valves at regular intervals can be seen. Blood flows with low pressure and the valves prevent backflow of blood.
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Portal vein A portal vein differs from the other normal veins in that it starts as capillaries from one organ and end in capillaries in some intermediate organ before taking the blood towards the heart Capillary These are a network of minute blood vessels. They are thin walled having a single layer of flat squamous epithelium resting on a single basement membrane. They are mainly involved in exchange of materials. Blood flows through the capillaries under high pressure. Wall of capillaries bear small endothelial pores or fenestrae through which blood cells (WBCs) can escape by the process called as diapedesis.
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Pulse Points Pulse It is a series of pressure waves that travel through the arteries due to ventricular systole. It is the strongest in arteries closer to the heart and gradually becomes weak in arteries away from heart. It can be felt easily in the superficial arteries like radial artery in the wrist and carotid artery in the neck. Pulse rate is equal to heart rate. Pulse rate higher than normal (above 100 beats/min) is called tachycardia and slower pulse rate (below 60 beats/min) than normal is called bradycardia.
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Blood pressure (B. P.) The pressure exerted by blood on the wall of the blood vessels is called blood pressure. It is measured by the sphygmomanometer. It is usually measured from the arteries. Arterial Blood Pressure Pressure exerted by blood on the wall of artery is arterial blood pressure. Pressure on arterial wall during ventricular contraction (systole) is systolic pressure (SP). For a normal healthy adult the average value is 120 mmHg. Pressure on arterial wall during relaxation of ventricles is diastolic pressure (DP). For a normal healthy adult it is 80 mmHg. B P = SP / DP = 120/80 mmHg Blood pressure is normally written as 120/80 mmHg. Difference between systolic and diastolic pressure is called pulse pressure. Normally, it is 40 mmHg
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Reasons for variation of blood pressure High or low blood volume, arterial inelasticity or hardening of arteries (arteriosclerosis), deposition of fats like cholesterol in the arteries (atherosclerosis), renal diseases and emotion induced hormonal changes, obesity, etc. Blood pressure lower than normal i.e. below 90/60 mmHg is called hypotension and blood pressure higher than normal i.e. above 140/90 mmHg is hypertension. Factors that affect the blood pressure Cardiac output, peripheral resistance, blood volume, length and diameter of blood vessels, viscosity of blood, age, gender, venous return, sleep, emotions, exercise, anxiety, etc.
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Measurement of blood pressure Blood pressure is measured with the help of an instrument called sphygmomanometer. This instrument consists of inflatable rubber bag cuff covered by a cotton cloth. It is connected with the help of tubes to a mercury manometer on one side and a rubber bulb on the other side. During measurement, the person is asked to lie in a sleeping position. The instrument is placed at the level of heart and the cuff is tightly wrapped around upper arm. The cuff is inflated till the brachial artery is blocked due to external pressure. Sphygmomanometer
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Then pressure in the cuff is slowly lowered till the first pulsatile sound is heard. At this moment, pressure indicated in manometer is systolic pressure. Sounds heard during measurement of blood pressure are called as Korotkoff sounds. Pressure in the cuff is further lowered till any pulsatile sound cannot be heard due to smooth blood flow. At this moment, pressure indicated in manometer is diastolic pressure. An optimal blood pressure (normal) level reads 120/80 mmHg.
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Electrocardiogram Graphical recording of electrical variations detected at the surface of body during their propagation through the wall of heart is electrocardiogram (ECG). The instrument used for this recording is the ECG machine or electrocardiograph. Various electrodes are used for recording of signals. Four electrodes are positioned on limbs; two on arms and two on legs. These are limb electrodes. Six electrodes are positioned on chest. These are chest electrodes. In a normal record, three different waves are recognized as P-wave, QRS complex and T-wave. P-wave is a small upward deflection from baseline of graph. It represents the atrial depolarization.
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The QRS complex starts as a slight downward deflection from baseline, continues as sharp and large upright wave and ends as a downward wave. QRS complex represents the ventricular depolarization. T-wave is small, wide and upwardly elevated wave. It represents the ventricular repolarization. Significances ECG helps to diagnose the abnormality in conducting pathway, enlargement of heart chambers, damages to cardiac muscles, reduced blood supply to cardiac muscles and causes of chest pain. A physical can find out the defect in the heart by examining the wave pattern and the time interval between them.
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REGULATION OF CARDIAC ACTIVITY Normal activities of the heart are regulated intrinsically, i.e., auto regulated by specialized muscles (nodal tissue), hence the heart is called myogenic. A special neural center in the medulla obligate can moderate the cardiac function through autonomic nervous system (ANS). Neural signals through the sympathetic nerves (part of ANS) can increase the rate of heart beat, the strength of ventricular contraction and thereby the cardiac output. On the other hand, parasympathetic neural signals (another component of ANS) decrease the rate of heart beat, speed of conduction of action potential and thereby the cardiac output. Adrenal medullary hormones can also increase the cardiac output.
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Angiography X-ray imaging of the cardiac blood vessels to locate the position of blockages is called angiography. Depending upon the degree of blockage, remedial procedures like angioplasty or by-pass surgery are performed. In angioplasty, a stent is inserted at the site of blockage to restore the blood supply while in by-pass surgery, the atherosclerotic region is by- passed with part of vein or artery taken from any other suitable part of the body, like hands or legs. Heart Transplant Replacement of severely damaged heart by normal heart from brain-dead or recently dead donor is called heart transplant. Heart transplant is necessary in case of patients with end-stage heart failure and severe coronary arterial disease.
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DISORDERS OF CIRCULATORY SYSTEM Hypertension Persistently raised blood pressure higher than the normal is called hypertension. 140/90 mmHg is called as threshold of hypertension and the 180/120 mmHg and higher readings are dangerous to the health. It may damage the heart, brain and kidneys. Coronary Artery Disease (CAD) It is also known as atherosclerosis. In this, calcium, fat cholesterol and fibrous tissues gets deposited in blood vessels suppling blood to the heart muscles making the lumen narrow. Angina Pectoris It is the pain in the chest resulting from a reduction in the blood supply to the cardiac muscles because of atherosclerosis or arteriosclerosis. It is characterized by severe pain and heaviness in the chest. The pain may spread to the neck, lower jaw, left arm and left shoulder. The pain usually results from exertion, when there is more demand of oxygen by the heart, but the supply does not meet the requirement.
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Silent Heart Attack Silent heart attack, also known as silent myocardial infarction is a type of heart attack that lacks the general symptoms of classic heart attack like extreme chest pain, hypertension, shortness of breath, sweating and dizziness. Symptoms of silent heart attack are so mild that a person often confuses it for regular discomfort and thereby ignores it. It has been studied that men are more affected by silent heart attack than women. Heart Failure Heart failure means the state of heart when it is not pumping blood effectively enough to meet the needs of the body. It is sometimes called congestive heart failure because congestion of the lungs is one of the main symptoms of this disease. Heart failure is not the same as cardiac arrest (when the heart stops beating) or a heart attack (when the heart muscle is suddenly damaged by an inadequate blood supply).
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