Heart failure: classification and pathophysiology

Abstract

Heart failure (HF) is a syndrome consisting of symptoms (including breathlessness, fatigue and orthopnoea) that is often accompanied by clinical signs (including peripheral oedema, elevated venous pressure and respiratory findings) caused by a structural and/or functional abnormality of the heart. It is crucial that healthcare professionals consider a diagnosis of HF when a person presents with such symptoms or signs. In individuals in whom a diagnosis of HF is suspected, timely assessment by a specialist helps to confirm or refute the diagnosis. If HF is present, this assessment should classify the type and aetiology as identifying differing aetiologies can result in a more tailored therapeutic approach. HF can present with an insidious progression of symptoms, or acutely with a decompensation of the underlying chronic pathology or secondary to an acute event such as a myocardial infarction. Cardiac dysfunction activates a cascade of hormonal, neuronal, metabolic and inflammatory pathways that, without treatment, lead to progression of HF and other end-organ dysfunction.