A general theory of acute and chronic heart failure

David H. MacIver*, Mark J. Dayer, Andrew J L Harrison

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)peer-review

29 Citations (Scopus)

Abstract

Current concepts of heart failure propose multiple heterogeneous pathophysiological mechanisms. Recently a theoretical framework for understanding chronic heart failure was suggested. This paper develops this framework to include acute heart failure syndromes.

We propose that all acute heart failure syndromes may be understood in terms of a relative fall in left ventricular stroke volume. The initial compensatory mechanism is frequently a tachycardia often resulting in a near normal cardiac output. In more severe forms a fall in cardiac output causes hypotension or cardiogenic shock. In chronic heart failure the stroke volume and cardiac output is returned to normal predominantly through ventricular remodeling or dilatation. Ejection fraction is simply the ratio of stroke volume and end-diastolic volume. The resting stroke volume is predetermined by the tissue's needs; therefore, if the ejection fraction changes, the end-diastolic volume must change in a reciprocal manner.

The potential role of the right heart in influencing the presentation of left heart disease is examined. We propose that acute pulmonary edema occurs when the right ventricular stroke volume exceeds left ventricular stroke volume leading to fluid accumulation in the alveoli. The possible role of the right heart in determining pulmonary hypertension and raised filling pressures in left-sided heart disease are discussed. Different clinical scenarios are presented to help clarify these proposedmechanisms and the clinical implications of these theories are discussed. Finally an alternative definition of heart failure is proposed. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)25-34
Number of pages10
JournalInternational Journal of Cardiology
Volume165
Issue number1
DOIs
Publication statusPublished - 30 Apr 2013

Keywords

  • Heart failure
  • Stroke volume
  • Ejection fraction
  • End-diastolic volume
  • Pathophysiology
  • Pathogenesis
  • PRESERVED EJECTION FRACTION
  • FRANK-STARLING MECHANISM
  • VENTRICULAR SYSTOLIC FUNCTION
  • EXERCISE CAPACITY
  • BLOOD-FLOW
  • VENOUS-PRESSURE
  • PULMONARY-EDEMA
  • CONSCIOUS DOGS
  • STROKE VOLUME
  • ARTERIAL

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