What is heart failure?

Heart failure is the inability of the heart to supply adequate blood flow and
therefore oxygen delivery to peripheral tissues and organs. Under perfusion of
organs leads to reduced exercise capacity, fatigue, and shortness of breath. It
can also lead to organ dysfunction (e.g., renal failure) in some patients.
What is the incidence of heart failure and its prognosis?
It is estimated that there are more than 15 million new cases of heart failure each
year worldwide. There are more than 600,000 new cases of heart failure
diagnosed each year in the USA, and ten times that number of Americans
currently in heart failure. The numbers are rapidly increasing because of the
aging population. Heart failure is the leading cause of hospitalization of patients
over 65 years in age.
Despite many new advances in drug therapy and cardiac assist devices, the
prognosis for chronic heart failure remains very poor. One year mortality figures
are 50-60% for patients diagnosed with severe failure, 15-30% in mild to
moderate failure, and about 10% in mild or asymptomatic failure.
What are the causes of heart failure?
Causes of Heart Failure
Myocardial infarction
Coronary artery disease
Chronic hypertension
Valve disease
Idiopathic cardiomyopathy
Viral or bacterial cardiomyopathy
Myocarditis
Pericarditis
Arrhythmias
Congenital heart disease
Diabetes
Thyroid disease
Pregnancy
Septic shock
Heart failure is a clinical syndrome caused by disease or other abnormal
conditions in the body. Heart failure can be caused by factors originating from
within the heart (i.e., intrinsic disease or pathology) or from external factors that
place excessive demands upon the heart. Intrinsic disease includes conditions
such as dilated cardiomyopathy and hypertrophic cardiomyopathy. External
factors that can lead to heart failure include long-term, uncontrolledhypertension,
increased stroke volume (volume load; arterial-venous shunts), hormonal
disorders such as hyperthyroidism, and pregnancy.
Acute heart failure develops rapidly and can be immediately life threatening
because the heart does not have time to undergo compensatory adaptations.
Acute failure (hours/days) may result from cardiopulmonary by-pass surgery,
acute infection (sepsis), acute myocardial infarction, valve dysfunction, severe
arrhythmias, etc. Acute heart failure can often be managed successfully by
pharmacological or surgical interventions.
Chronic heart failure is a long-term condition (months/years) that is associated
with the heart undergoing adaptive responses (e.g., dilation, hypertrophy) to a
precipitating cause. These adaptive responses, however, can be deleterious in
the long-term and lead to a worsening condition.
The number one cause of heart failure is coronary artery disease (CAD). CAD
reduces coronary blood flow and oxygen delivery to the myocardium. This leads
to myocardial hypoxia and impaired function. Another common cause of heart
failure is myocardial infarction, which is the final and often fatal culmination of
CAD. Infarcted tissue does not contribute to the generation of mechanical activity
so overall cardiac performance is diminished. Furthermore, non-infarcted regions
must compensate for the loss of function and this extra burden can precipitate
changes that lead to failure. Valvular disease and congenital defects place
increased demands upon the heart that can precipitate failure.
Cardiomyopathies, of known origin (e.g., bacterial or viral) or idiopathic (unknown
origin), can lead to failure. Myocarditis can have a similar
effect. Arrhythmias such as severe bradycardia or tachycardia can also
precipitate failure.