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58 Cardio Diabetes Medicine 2017

Progressive Heart Failure –Etiopathogenesis,

Invasive and Noninvasive Evaluation

Dr. G. Justinpaul, Professor Cardiology,
Madras Medical College

Dr. J. Cecilymarymajella, Assistant Professor Cardiology
Madras Medical College

ABSTRACT of progressive and declining ventricular function,
The term‘progressive heart failure [PHF]’ is used following an initial cardiac insult with or without an
to describe patients with increasing severity of intervening period of stable heart failure. Data and
symptoms, frequent decompensation and pro- evidence show that autonomic and neuro-humoral
gressive cardiacdysfunction. The aetio-pathogen- mechanisms play a crucial role in this progressive
esis of heart failure is varied and diverse among decline in cardiac function. Drugs which specifically
various parts of the world. Early and prompt iden- inhibit neurohumoral mechanisms have been shown
tification of these diverse pathologies is an im- to prolong survival by slowing disease progression.
portant part of the diagnostic armamentarium, as Variables that help in reflecting the magnitude of
they would offer better therapeutic opportunities. neurohumoral dysfunction, will be useful to identify
patients with chronic compensated heart failure who
Over the last 3 decades, advancements in treatment are at an increasedpropensity in entering a decom-
protocols have improved survival rates and de- pensated spiral of declining ventricular function, de-
creased the rate of hospitalization and reduced the clininghemodynamics, and mortality due to progres-
rate of progression in heart failure patients. Accurate siveheartfailure.
evaluation and estimation of prognosis for morbidity
and mortality helps patients, their family members DEFINITION OF HEART FAILURE
and treatingphysicians to plan the appropriate ther- HF is a clinical syndrome characterized by typical
apies. Numerous prognostic markers of progressive symptoms (e.g. breathlessness, ankle swelling and
heart failure have been recognized and validated. fatigue) that may be accompanied by signs (e.g. el-
But their clinical utility and application is limited and evated jugular venous pressure, pulmonary crackles
precise risk stratification in progressive heart failure and peripheral edema) caused by a structural and/
remains a great challenge. Cardiac imaging plays a or functional cardiac abnormality, resulting in a re-
pivotal role in the diagnosis of heart failure and aids duced cardiac output and/or elevated intracardiac
in guiding and planning treatment protocols. pressures at rest or during stress.

The current definition of HF restricts itself to stag-
es at which clinical symptoms are apparent. Before
INTRODUCTION: clinical symptoms become apparent, patients can
Heart failure is a syndrome where tremendous ad- present with asymptomatic structural or functional
vancementin understanding the etiopathogenetic, cardiac abnormalities [systolic or diastolic left ven-
pathophysiology, diagnosis and treatment modali- tricular (LV) dysfunction], which are precursors of HF.
ties have taken place in the last few decades. Yet Recognition of these precursors is important because
mortality rates in ambulatory HFpatientscontinue they can guide the therapy, starting therapy early can
to hover around10% per year. A major proportion improve prognosis and left untreated they lead to
of these deaths are primarily due to a progressive poor outcome.
and rapid decline in left ventricular function. It is not Classification of Heart failure: Patients with HF are
yet clear why some individuals enter into a phase
often classified with respect to the LVEF, as this has

GCDC 2017