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                                           HEART  FAILURE

                                                            Andrew Ying-Siu Lee, MD,PhD.

              When the heart cannot pump efficiently so as to maintain good circulation to supply nutrients and metabolic needs

for the body, heart failure is said to occur, which is the end-stage of all kinds of cardiovascular diseases.  No matter are

there coronary artery disease, valvular heart disease, myocarditis, hypertension, autoimmune disease, infection, metabolic

disease, or congenital diseases, they may cause structural and functional dysfunction of the heart, which may damage the

pumping action of the heart leading to end-stage heart disease with refractory heart failure.

              Common symptoms of heart failure include: dyspnea, decreased exercise tolerance, exertional dyspnea, dyspnea

when lying flat, weakness, edema, abdominal fullness, palpitation, dizziness or fainting etc.  Are there precipitating factors

such as incompliance, emotional disturbance, cardiac arrhythmias, infection, anemia, uncontrolled hypertension, or

concurrent diseases such as thyroid , pulmonary , gastrointestinal and renal diseases, heart failure may worsen to death.

              According to New York Heart Association, the severity of heart failure can be classified into :-

Grade 1   :  there are no symptom of heart failure such as weakness, palpitation, dyspnea, chest discomfort etc

                  upon ordinary activity.

Grade 2   :  ordinary activity will elicit symptoms of heart failure

Grade 3   :  less than ordinary activity will elicit symptoms of heart failure

Grade 4   :  symptoms of heart failure occur at rest

And the 5-year mortality of heart failure :-

       Grade 2-3            34%

       Grade 4              82%

 Factors to assess severity and prognosis of heart failure include:-

        Clinical: age, male, coronary artery disease, New York Heart Association class, exercise capacity, heart rate at rest,

                      systolic arteral pressure,  cardiac cachexia, history of hospitalization

        Hemodynamic: ejection fraction, cardiac output

        Biochemical: plasma norepinephrine, renin, vasopressin, atrial and brain natriuetic peptides, endothelin, interleukin,

                              sodium, potassium, magnesium

        Electrophysiological: LBBB, wide QRS, arhyhmias

                     Therapy of heart failure include: (1) symptomatic treatment, to relieve whatever symptoms the patients have. 

However, heart failure continues to worsen and eventually leads to end-stage heart disease (refractory heart failure),

(2) treatment of causes, to explore and treat the etiological factors of heart failure such as coronary artery disease,

valvular heart disease, diabetes mellutis, thyroid disease etc.  This may relieve or cure heart failure if the etiological

factors can be well controlled, (3) device therapy such as ultrafiltration, resynchronization, implantable defibrillation,

ventricular assist device, artificial heart etc. (4) heart transplantation.  Therefore treatment of causes of heart failure is

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