Pathophysiology of Heart Failure

Abstract

Heart failure (HF) is a complex clinical syndrome that centers on the heart’s impaired ability to support physiologic circulation. A wide range of etiologies can be responsible for HF, including but not limited to ischemic heart disease, valvular heart disease, infiltrative disease, restrictive physiology, genetic conditions, and idiopathic cardiomyopathy. The cardinal manifestations are dyspnea and fatigue. The syndrome of HF is a continuum of interrelated stages, starting from an asymptomatic with risk factors for HF or evidence of structural changes in the heart to debilitating functional limitations related to dyspnea and a high risk of sudden cardiac death. Guideline-directed medical therapy has most successfully improved morbidity and mortality in patients with reduced left ventricular ejection fraction, while therapy for patients with preserved ejection fraction largely focuses on symptomatic management. For patients with advanced HF who are refractory to conventional therapy, including oral agents, implantable electronic cardiac devices, and comprehensive care interventions, options may include inotropic therapy, mechanical circulatory support, cardiac transplantation, or transition to comfort-focused care.