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Heart Failure: Overview and Risk Factors  

Heart failure is the inability of the heart to deliver adequate oxygen to the body’s peripheral tissues. Primarily a disease of elderly persons, heart failure affects more than 5 million Americans. It can develop in anyone with a history of hypertension, myocardial infarction (MI), coronary heart disease (CHD), valvular heart disease, or diabetes, among other disorders.

Heart failure may be right–sided or left–sided. Signs and symptoms of right–sided failure include increased jugular venous pressure, pleural effusions, right upper quadrant or abdominal discomfort, hepatomegaly, ascites and/or jaundice, and peripheral edema. Left–sided failure is characterized by dyspnea, orthopnea, and paroxysmal nocturnal dyspnea, attributable to elevated pulmonary pressure with or without pulmonary edema. Acute heart failure often causes prominent dyspnea, diaphoresis, tachycardia, and pale, cold extremities. 

Low–output heart failure is marked by decreased cardiac output, and is most often caused by hypertension, myocardial infarction, or chronic coronary artery disease. High–output heart failure is often caused by anemia or hyperthyroidism.

The most common proximate cause of heart failure is left–ventricular systolic dysfunction, which is marked by reduced myocardial contractility, resulting in low stroke volume. Diastolic dysfunction (myocardial stiffness and impaired relaxation) produces heart failure due to elevated ventricular filling pressure. It is usually due to hypertension and often occurs without associated systolic dysfunction. In some studies, diastolic dysfunction accounts for as many as half of heart failure diagnoses. It is more common in women.

Complications of heart failure include limiting symptoms, syncope, dysrhythmias (which may be lethal), progressive systolic or diastolic dysfunction, thromboembolism (usually strokes), and circulatory collapse.

Risk Factors 

Compared with white Americans, African Americans often experience worse outcomes from heart failure and are at greater risk of death. Other risk factors include:

Age. The likelihood of heart failure and left–ventricular dysfunction increases with age.

History of MI or CHD. Left ventricular dysfunction often results from ischemic injury to the myocardium.

History of cardiomyopathy. Family or personal history of dilated, hypertrophic, or restrictive cardiomyopathy.

History of rheumatic fever or valvular heart disease.

Pericardial disease.

Hypertension. Pulmonary hypertension generally leads to right–sided heart failure, whereas systemic hypertension leads to left–sided heart failure.

Obesity. Hypertension and left ventricular hypertrophy are commonly found in obese patients.

Diabetes. Diabetic cardiomyopathy causes left ventricular dysfunction.

Alcohol abuse. Alcohol toxicity may lead to dilated cardiomyopathy.

 

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Heart Failure: Diagnosis >>