Pathophysiology of Heart Failure
Heart failure refers to the inability of the heart to pump enough blood to meet the body’s needs (Braunwald et al., 2018). It occurs when the heart muscle is weakened or damaged and cannot contract with enough force. There are two main types of heart failure – heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).
In HFrEF, the heart muscle is unable to contract normally, causing the left ventricle to fail to eject a sufficient amount of blood with each heartbeat. Common causes include a previous heart attack which damages the heart muscle, long-standing high blood pressure, and cardiomyopathies (Braunwald et al., 2018). Over time, the weakened heart becomes enlarged and less able to pump blood efficiently.
In HFpEF, the heart muscle contracts normally but the ventricle does not relax as well as it should between beats. This prevents the ventricle from filling with enough blood. Risk factors include high blood pressure, diabetes, obesity, and older age (Ponikowski et al., 2016). The exact causes are still under investigation but may involve stiffening of the heart muscle.
The pathophysiology of both types of heart failure involves neurohormonal activation and maladaptive remodeling of the heart muscle in response to the initial injury or stress (Ponikowski et al., 2016). This leads to further impairment of cardiac function in a vicious cycle. Symptoms occur due to fluid backup in the lungs or other tissues.
Treatment aims to relieve symptoms, improve cardiac function, and reduce the risk of hospitalization and death. Medications target neurohormonal systems and manage fluid levels (Ponikowski et al., 2016). Lifestyle changes like salt restriction and exercise are also important. For some advanced cases, devices like implantable cardioverter-defibrillators or cardiac resynchronization therapy may be used. Heart transplantation is an option for carefully selected patients.
In summary, heart failure develops via different mechanisms but ultimately results in the heart’s inability to pump enough blood for the body’s needs. Understanding the pathophysiology guides treatment and management approaches for this prevalent cardiovascular condition.
Braunwald, E., Zipes, D. P., & Libby, P. (2018). Braunwald’s heart disease E-Book: A textbook of cardiovascular medicine. Elsevier Health Sciences.
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G., Coats, A. J., … & van Veldhuisen, D. J. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European heart journal, 37(27), 2129-2200.

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