Pathophysiology of Heart Failure

摘要: Heart failure (HF) has become a public health issue that is so important it been named “new epidemic of cardiovascular disease,” and its prognosis poor. The 5-yr mortality rate in patients with mild HF approx 50%; the annual mortalities depend on disease severity range from <5% asymptomatic to 30–80% endstage disease, 10% 20–30% moderate (1). Today, single most frequent cause hospitalization persons 65 yr age or older becomes more common increasing age. increase aging population growing number people surviving myocardial infarctions are reasons why prevalence rising steadily. Fortunately, during last three decades substantial improvements diagnosis, management, treatment have achieved. Drugs available demonstrated unequivocally delay death, enable avoid hospitalization, improve quality life assessed by exercise capacity symptoms questionnaires. In 1970s was perceived as were closely allied hemodynamic disequilibrium. This model suggested increased ventricular wall stress principal HF. It thought these abnormalities can be rectified use vasodilating drugs lead afterload reduction. These fact lowered left atrial pressure cardiac output, acute rapidly improved such diuretics, vasodilators, morphine. response relates largely changes central hemodynamics. However, soon realized administration some afterload-reducing not associated any clinical benefit patients’ outcomes even after improvement status had origin chronic (CHF) related simple manner findings well (2). discoveries led for­mulation neurohormonal hypothesis progression (3). recent years much learned about pathophysiology HF, today regarded disorder due impaired pump function reduced output subsequent venous congestion. Complex activation aimed at improv­ing mechanical environment heart, circulating local hormones proinflammatory cytokines play an role progression. fact, developments intro­duction first angiotensin converting enzyme (ACE) inhibitors then s-blockers, which resulted almost 50% decrease decade therapeutic trials. great benefits delaying mainly attributable their neurohumoral effects beneficial remodeling failing heart. chapter focuses complex diagnostic implications.