Heart failure occurs when abnormal cardiac function causes failure of the heart to pump blood at a rate sufficient for metabolic requirements under normal filling pressure. It is characterised clinically by breathlessness, effort intolerance, fluid retention, and poor survival. Fluid retention and the congestion related to this can often be relieved with diuretic therapy. However, diuretic therapy should generally not be used alone and, if required, should be combined with the pharmacological treatments outlined in this review. Heart failure can be caused by systolic or diastolic dysfunction, and is associated with neurohormonal changes. Left ventricular systolic dysfunction (LVSD) is defined as a left ventricular ejection fraction (LVEF) <0.40. It may be symptomatic or asymptomatic. Defining and diagnosing diastolic heart failure can be difficult. Proposed criteria include: (1) clinical evidence of heart failure; (2) normal or mildly abnormal left ventricular systolic function; (3) evidence of abnormal left ventricular relaxation, filling, diastolic distensibility, or diastolic stiffness; and (4) evidence of elevated N-terminal-probrain natriuretic peptide. However, assessment of some of these criteria is not standardised.
Individual Prediction of Heart Failure Among Childhood Cancer Survivors. ( 17 December 2014 )
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