Post MI Heart Failure
Definitions and Types of Heart Failure
Definition of heart failure
Heart failure (HF) has been defined succinctly as a complex syndrome that can result from any structural or functional cardiac disorder that reduces the ability of the heart to function as a pump to support a physiological circulation.1
In 2008, the European Society of Cardiology (ESC)2 described HF as a clinical syndrome defined by the presence of both signs and symptoms of HF (e.g. breathlessness and raised jugular venous pressure), with objective evidence of a structural or functional cardiac abnormality at rest (Figure 1).
Types of heart failure
HF can be classified in a number of different ways: systolic or diastolic HF; new-onset, transient or chronic HF; right or left HF; high or low output HF; mild, moderate or severe HF.
According to the ESC, diastolic and systolic forms of HF should not be considered separate entities.2 Patients with diastolic HF have symptoms and signs of HF and a preserved ejection fraction of 45-50%; the defect in diastolic HF is a reduced ability of the myocardium to relax during diastole, leading to impaired ventricular filling and hence reduced cardiac output.3 However, most patients with HF have evidence of both systolic and diastolic HF at rest or on exercise.2
Other forms of HF are described in Table 1.
Severity of HF can also be described using the scale developed by the New York Heart Association (NYHA), which is based on functional status.
Post-MI heart failure is a form of new-onset HF that usually results from damage to the myocardium following prolonged ischaemia.
Figure 1. European Society of Cardiology definition of heart failure (HF).2
| Types of HF | Description |
|---|---|
| New onset |
First presentation Sudden or gradual in onset |
| Transient | Recurrent or episodic HF that may require treatment, but which is due to a reversible defect in cardiac function (e.g. myocardial impairment during ischaemia that is restored upon revascularisation) |
| Chronic | Persistent HF that may be stable, worsening or decompensated. Worsening, chronic HF is the most common form leading to hospital admission |
| Right | Presents as congestion of the systemic venous circulation, leading to signs of fluid retention with ankle swelling. Often secondary to left-sided HF |
| Left | Presents as congestion of the pulmonary circulation, leading to pulmonary oedema |
| High output | Symptoms and/or signs of HF occurring in the presence of high cardiac output. Associated with (for example) anaemia, thyrotoxicosis and septicaemia |
| Mild | Describes ambulatory patients in whom dyspnoea and fatigue do not limit functioning |
| Moderate | Patients with HF who do not fall into ‘mild’ or ‘severe’ classifications |
| Severe | Patients with marked symptoms who require frequent medical attention |
References:
- National Institute for Health and Clinical Excellence. Chronic heart failure: national clinical guideline for diagnosis and management in primary and secondary care. NICE Guideline no 5: Royal College of Physicians, 2003.
- Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. Eur Heart J 2008;29:2388-442.
- Kumar P, Clark M. Clinical medicine. 7th ed. Edinburgh: Saunders Elsevier, 2009.