Abstract

August 2006

Section 1 Cardiovascular Medicine

Heart failure is a clinical syndrome resulting from a structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood to meet the needs of the body. This syndrome, which is a constellation of signs and symptoms, is primarily manifested by dyspnea, fatigue, fluid retention, and decreased exercise tolerance. Heart failure can be classified in terms of the underlying cardiomyopathy or as primarily systolic dysfunction or diastolic heart failure. A classification system from the American College of Cardiology/American Heart Association (ACC/AHA), which was updated in 2005, emphasizes the evolution and progression of heart failure and has defined four stages of the disorder. Remodeling, a structural response to myocardial injury, is one of several pathophysiologic mechanisms for heart failure. Diagnosis should identify patients at risk of heart failure as well as asymptomatic and symptomatic patients. Treatment is keyed to the stage of the disorder and includes risk reduction, diuretics, ACE inhibitors, angiotensin receptor blockers (ARBs), beta blockers, digoxin, aldosterone antagonists (e.g., spironolactone and eplerenone), and inotropic agents. Treatment may also involve revascularization, surgery, heart transplantation, biventricular pacing, and cardioverter-defibrillators. Figures illustrate the different cardiac morphologies in heart failure, the evolution of heart failure by stage, and survival trends in heart failure since the 1950s. Tables list examples of descriptive and etiologic classifications of heart failure, as well as the stages, treatment, and pharmacotherapy of heart failure. This chapter contains 133 references.

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