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Upon completion of the chapter, the reader will be able to:

  1. Differentiate between the common underlying etiologies of heart failure (HF), including ischemic, nonischemic, and idiopathic causes.

  2. Describe the pathophysiology of HF as it relates to neurohormonal activation of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS).

  3. Identify signs and symptoms of HF and classify a given patient by New York Heart Association Functional Classification and American College of Cardiology/American Heart Association Heart Failure Staging.

  4. Describe the goals of therapy for a patient with acute or chronic HF.

  5. Develop a nonpharmacologic treatment plan that includes patient education for managing HF.

  6. Develop a specific evidence-based pharmacologic treatment plan for a patient with acute or chronic HF based on disease severity and symptoms.

  7. Formulate a monitoring plan for the nonpharmacologic and pharmacologic treatment of a patient with HF.


Heart failure (HF) is defined as the inadequate ability of the heart to pump enough blood to meet the blood flow and metabolic demands of the body.1 High-output HF is characterized by an inordinate increase in the body’s metabolic demands that outpaces an increase in cardiac output (CO) of a generally normally functioning heart. More commonly, HF is a result of low CO secondary to impaired cardiac function. The term heart failure refers to low-output HF for the purposes of this chapter.

HF is a clinical syndrome characterized by a history of specific signs and symptoms related to congestion and hypoperfusion. Because HF can occur in the presence or absence of fluid overload, the term heart failure is preferred over the former term congestive heart failure. HF results from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood.1 Many disorders, such as those of the pericardium, epicardium, endocardium, or great vessels, may lead to HF, but most patients develop symptoms due to impairment in left ventricular (LV) myocardial function.

The term acute heart failure (AHF) is used to signify either an acute decompensation of a patient with a history of chronic HF or to refer to a patient presenting with new-onset HF symptoms. Terms commonly associated with HF, such as cardiomyopathy and LV dysfunction, are not equivalent to HF but describe possible structural or functional reasons for the development of HF.



HF is a major public health concern affecting approximately 5.1 million people in the United States. An additional 825,000 new cases are diagnosed each year. HF manifests most commonly in adults older than 60 years.2 The growing prevalence of HF corresponds to (a) better treatment of patients with acute myocardial infarctions (MIs) who will survive to develop HF later in ...

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