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Revascularization and Surgical Therapy
Overview of Heart Failure
Congestive heart failure, also known as heart failure (HF) is a condition which results from any structural or functional heart disorder that impairs the heart’s ability to pump sufficient blood through the body. Although HF can occur at any age, it is more common among the elderly people as age-related changes tend to reduce the functional efficiency of the heart. Further, this group of the population is more likely to have disorders that damage the heart muscle.
Heart failure constitutes a major public health problem in theWestern world. This condition affects nearly five million Americans with anincidence nearly 10 per 1000 persons among individuals above 65 years of age.1 Five-year survival rates of HF patients had been estimated to be only 45% in women and 59% in men.2
The diagnosisof HF is complex. Early diagnosis of HF is essential in order to adequately control the underlying disease or causes. Evaluation of symptomatic patients with suspected HF focuses on confirming the diagnosis, determining the cause, identifying concomitant illnesses, establishing the severity and directing the therapy. The goals of the HF therapy include targets on improving the survival by slowing down the disease progression, alleviating the symptoms and minimizing the risk factors. Lifestyle modificationshelp in controlling the symptoms and improving the quality of life.
There are many different ways to classify HF. Each depends upon the following criteria:
- The side of the affected heart—left HF or right HF.
- The type of the abnormality—either due to contraction (systolic dysfunction) or relaxation (diastolic dysfunction) of the heart.
- The cause of the failure—either due to low cardiac output or high systemic vascular resistance (low- vs. high-output failure).
- The extent of functional impairment caused by the abnormality.
The New York Heart Association (NYHA) Functional Classification is widely used in the clinical practice and in clinical studies to quantify the clinical assessment of HF and to assess response to the treatment.3 The NYHA functional classifications based on physical activities are:which documents severity of symptoms
- Class I: No limitation in any activities.
- Class II: Mild limitation of activity.
- Class III: Marked limitation of any activity.
- Class IV: Symptoms of HF occur even at rest.
Clinical Features (Symptoms of Heart Failure)
Symptoms of HF are largely determined by side of the heart (left or right), which fails. The clinical features of HF are mainly due to an accumulation of fluid in the lungs and the body. These symptoms are based on the affected
Read more....
Diagnosis of Heart Failure
According to the European Societyof Cardiology guidelines, in addition to typical symptoms suggestive of the diagnosis of HF, objective evidenceof cardiac dysfunction has to be present to establish the presenceof HF.5The Read more....
Treatment of Heart Failure
The management of HF depends on its cause and clinical course, therefore an individualized approach to the treatment is mandatory. Diuretics and angiotensin converting enzyme (ACE) inhibitors, when combined with
Read more....
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Written by: Healthplus24 team
Date last updated: January 08,2009
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- Jessup M, Brozena S. Heart failure. N Engl J Med. 2003; 348: 2007–2018.
- Levy D, Kenchaiah S, Larson MG, Benjamin EJ, Kupka MJ, Ho KK, et al. Long-term trends in the incidence of and survival with heart failure. N Engl J Med. 2002; 347: 1397–1402.
- Criteria Committee of the New York Heart Association. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. 9th ed. Boston: Little, Brown, 1994.
- Gheorghiade M, Bonow RO. Chronic heart failure in the United States: A manifestation of coronary artery disease. Circulation. 1998; 97: 282–289.
- Remme WJ, Swedberg K. Guidelines for the diagnosis and treatment of chronic heart failure. Task Force for the diagnosis and treatment of chronic heart failure, European Society of Cardiology. Eur. Heart J. 2001; 22: 1527–1560.
- Hunt SA, Baker DW, Chin MH, Cinquegrani MP, Feldman AM, Francis GS, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2001; 38: 2101–2113.
- Jessup M, Brozena S. Heart failure. N Engl J Med. 2003; 348(20): 2007–2018.
- Smith A, Aylward P, Campbell T, et al. Therapeutic Guidelines: Cardiovascular, 4th edition. North Melbourne: Therapeutic Guidelines; 2003. ISSN 1327–9513.
- Tsuyuki RT, Shrive FM, Galbraith PD, Knudtson ML, Graham MM; APPROACH Investigators. Revascularization in patients with heart failure. CMAJ. 2006; 175(4): 361-365.
- Baumgartner WA. What's new in cardiac surgery? J Am Coll Surg. 2001; 192: 345–355.
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