Pathophysiology in Heart Failure

Abstract

Heart failure syndrome is defined as the inability of the heart to deliver adequate blood to the body to meet end-organ metabolic needs and oxygenation at rest or during mild exercise. Myocardial dysfunction can be defined as systolic and/or diastolic, acute or chronic, compensated or uncompensated, or uni-or biventricular. Several counterregulatory mechanisms are activated depending on the duration of the heart failure. Neurohormonal reflexes such as sympathetic adrenergic system, renin-angiotensin cascade, and renal and peripheral alterations attempt to restore both cardiac output and end-tissue perfusion. An adequate stroke volume cannot be ejected from the left ventricle, which shifts the whole pressure-volume relationship to the right (systolic failure). Adequate filling cannot be realized due to diastolic stiffness, which shifts the diastolic pressure-volume curve upward without affecting the systolic pressure-volume curve (diastolic failure). Left ventricular heart failure is the dominant picture of heart failure syndrome, but the right heart can develop isolated failure as well. Biventricular failure is mostly an end-stage clinical situation of the heart failure syndrome. More recently, the rise in the incidence of right ventricular failure can be seen after the implantation of a left ventricular assist device. This chapter clarifies and presents pathophysiologic alterations in heart failure syndrome.

Pupil reflex as a marker of activity and prognosis in heart failure: a longitudinal and prospective study

“…HF stands as the foremost cause of hospitalization among individuals older than 65, representing 1-2% of total hospital admissions in Western countries. 5,6 This condition affects over 60 million people globally and currently constitutes a worldwide pandemic, incurring substantial healthcare expenditures and diminishing patients' quality of life. 7,8 Given the widespread prevalence and implications of HF, its prompt recognition and effective management are imperative.…”

Exercise Training Post Cardiac Resynchronization Therapy Improves Exercise Tolerance and Quality of Life

“…Due to the ensuing inadequacy in the supply of oxygenated blood to end organs and peripheral tissues, heart failure syndrome manifests as a systemic disease affecting multiple organs. The condition is often exacerbated by neurohormonal compensatory mechanisms that try to restore cardiac function but turn out as counterproductive [3]. HF can be acute (AHF) or chronic (CHF) based on the time of onset.…”

Finding a Needle in a Haystack

“…Furthermore, in the case of natriuretic peptides, biomarker testing provides clinical value, informing diagnosis, prognosis, and therapy decision-making ( 1 , 2 , 3 , 4 ). Despite its enormous value in HF, natriuretic peptide testing fails to reflect all pathophysiological aspects, which beyond cardiac myocyte stretching, also results in renal injury, fibrosis, and inflammation ( 5 , 6 , 7 ). For these reasons, an approach that reveals a broader spectrum of proteins in HF is necessary.…”