Case Presentation: Heart Failure
Definition of Heart Failure & Symptoms -
A syndrome caused by cardiac dysfunction generally resulting from myocardial muscle
dysfunction or loss. It is characterized by left ventricular dilatation or hypertrophy and leads to
neurohormonal and circulatory abnormalities and characteristic symptoms including fluid retention,
shortness of breath, and fatigue (especially on exertion).
Left untreated, it is usually progressive at the levels of cardiac function & clinical symptoms.
Severity of clinical symptoms may vary substantial during course of the disease process & may not
correlate with changes in underlying cardiac function.
Heart Failure - Physiological Characteristics -
In physiological terms, HF is characterized by elevated cardiac filling pressure (this is to
achieve adequate cardiac output and includes atrium & ventricle) OR inadequate peripheral oxygen
delivery, at rest or during stress, caused by cardiac dysfunction (low cardiac output)
2 Categories of HF -
1. HF with Reduced Left Ventricular Ejection Fraction (LVEF)
2. HF with Preserved LVEF
HF with Reduced Left Ventricular Ejection Fraction (LVEF) -
Also called "HF with a Dilated Left Ventricle" or "Dilated Cardiomyopathy"
A clinical syndrome characterized by signs and symptoms of HF and reduced LVEF (<50%). Most
commonly associated with LV chamber dilation.
HF with Preserved Left Ventricular Ejection Fraction (LVEF) -
Also called "HF with a Non-Dilated Left Ventricle"
A clinical syndrome characterized by signs & symptoms of HF with preserved LVEF. Most commonly
associated with a non-dilated LV chamber. It may be result of valvular disease or other causes.
Myocardial Remodeling -
Pathologic myocardial hypertrophy or dilation in response to increased myocardial stress.
These changes are generally accompanied by pathologic changes in the cardiac interstitium. Generally
a progressive disorder.
Ex: Patients w/cardiomyopathy have decreased density of interstitium. Patients w/diastolic heart failure
have increased density of interstitium.
Congestive Heart Failure Evaluation -
History: Most important
PE: Also important
