Year: 2012
Type: book-chapter
Abstract: Introduction 1.1 Evolving profile of heart failureThere have been many definitions of Heart Failure and yet the most recent definitions rely heavily on clinical manifestations: dyspnoea or undue fatigue on exertion, along with the evidence of fluid retention, supported by objective evidence of structural or functional abnormalities of the heart at rest.A more recent classification also recognizes and emphasizes the need for the above signs and symptoms for both the development and progression of heart failure (Dickstein et al., 2008).The 2009 update of the AHA guideline identifies patients at higher risk of developing or progressing more rapidly to heart failure as traditionally defined.Table 1.The presence of cardio-metabolic risk factors (hypertension, diabetes, obesity and metabolic syndrome) in addition to atherosclerotic disease puts the patient at twice greater risk of developing and/or progressing to heart failure as currently defined i.e. with structural or functional heart disease at rest.Studies across the world, particularly in India, China and Latin America suggest that overweight, metabolically challenged individuals are at greater risk of heart failure at a younger age and are also twice as likely to have heart failure linked events such as hospitalization or mortality (Clarke et al., 2010).Echocardiography and Doppler imaging of the heart are the current gold standards for identification of structural and to extent also functional abnormalities.Advances in Echocardiography and Doppler imaging have enabled the identification of an underdiagnosed entity described as diastolic dysfunction, an additional handicap for a failing heart.Prognosis of patients with predominant diastolic dysfunction (Heart Failure with Preserved Ejection Fraction: HFPEF) has been reported to be similar to those who have predominant systolic dysfunction.In some population surveys, up to 50% of patients fall in this category (Paulus, 1998).Many have co-morbidities identified as risk factors in Stage A of the AHA classification.It is therefore pertinent to understand why and how these additional risk factors influence the development and progression of heart failure as different from and often in addition to Atherosclerotic Coronary Artery Disease.Diabetes, hypertension, dyslipidemia and thyroid dysfunction affecting heart are often considered as factors contributing to coronary artery disease.However, there is evidence to www.intechopen.comCardiomyopathies -From Basic Research to Clinical Management 464 suggest that diabetes and hypertension may affect myocardial function largely independent of significant epicardial coronary artery disease.The main objective of this chapter is to explain holistic effects of cardio-metabolic risk factors on heart failure.We urge the reader to consider factors beyond the myocardium, such as vascular responsiveness, neuroendocrine maladaptation and renal function and correlate it with clinical manifestations.This chapter elucidates and correlates recent advances in understanding of etiological factors affecting the myocardial function, the mechanisms which could be influencing overall progression and presentation of heart failure, current diagnostic approaches, their limitations and emerging concepts, current medical therapies, their limitations and newer emerging therapeutic approaches.
Source: InTech eBooks
DOI: 10.5772/28065
Institution: Torrent Pharma (India)
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W1595292803