Taking a History in a Patient with Heart Failure

Abstract

Identification of the etiology of heart failure early in the course of the disease will allow the physician to institute pharmacologic therapies. These therapies may not only effectively ameliorate the symptoms of heart failure, but may also favorably alter the natural history of this disease process by addressing the neurohormonal influences that perpetuate injury in the failing heart. Furthermore, the identification of the pathophysiologic processes that have resulted in myocardial injury or dysfunction may allow the institution of therapies specifically directed at alleviating or reconciling those disorders. The identification of myocardial ischemia (e.g., contributing to myocardial hibernation) may direct the physician to provide therapies directed at improving myocardial blood flow and thereby improve cardiac function. Similarly, the identification of valvular lesions producing either pressure or volume overload may be reconciled by valve replacement or repair. A history of excessive alcohol consumption, a common cause of myocardial dysfunction, and subsequent avoidance of alcohol use, often results in improved cardiac function.