Chapter

Pathophysiology of systolic heart failure

Richard Cubbon and Ajay Shah

in Chronic Heart Failure

Published on behalf of Oxford University Press

ISBN: 9780199542338
Published online May 2011 | e-ISBN: 9780199607174 | DOI: http://dx.doi.org/10.1093/med/9780199542338.003.0002

Series: Oxford Cardiology Library

Pathophysiology of systolic heart failure

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• Chronic heart failure (CHF) is a clinical syndrome in which pathological stress or injury is associated with a failure of cardiac performance to meet the metabolic demands of the body and therefore results in clinical symptoms. • In the normal heart, cardiac output increases up to four fold during exercise; this response is diminished in CHF. • Multiple intrinsic and extrinsic control mechanisms exist to optimise cardiac performance, both acutely and chronically, through modulation of cardiac physiology and structure. • CHF is characterized by activation of a portfolio of compensatory mechanisms including activation of the renin-angiotensin-aldosterone and sympathetic nervous systems. • An index cardiac insult may initiate maladaptive compensatory mechanisms instigating a vicious cycle of progressive myocardial damage, hence resulting in a deteriorating clinical syndrome of CHF.

• Systole—the period of the cardiac cycle when ventricular activity occurs and blood is ejected • Diastole—the period of the cardiac cycle when the heart fills with blood • Cardiac cycle—the series of cardiac electromechanical events that comprise each beat • Heart rate—the number of cardiac cycles per minute • Chronotropy—modulation of heart rate • Stroke volume—the volume of blood ejected from the heart during systole • Inotropism—modulation of myocardial contractility • Lusitropism—modulation of cardiac relaxation • Cardiac output—the volume of blood pumped by the heart during 1 min • Preload—the stretching force experienced by the myocardium prior to onset of contraction • Afterload—the stretching force experienced by the myocardium during contraction • Remodelling—cardiac structural and functional adaptation in response to chronic changes in workload

Chapter.  3779 words.  Illustrated.

Subjects: Cardiovascular Medicine

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