).Figure 2: Click to Enlarge Right ventricular systolic dysfunction is usually a consequence of left ventricular systolicdysfunction. It may also develop as a result of right ventricular infarction, pulmonaryhypertension, chronic severe tricuspid regurgitation, or arrhythmogenic right ventriculardysplasia. A less common cause of heart failure is high-output failure caused by thyrotoxicosis,arteriovenous fistulae, Paget's disease, pregnancy, or severe chronic anemia.Diastolic left ventricular dysfunction (impaired relaxation) usually is related to chronichypertension or ischemic heart disease. Other causes include restrictive, infiltrative, andhypertrophic cardiomyopathies. Inadequate filling of the right ventricle may result frompericardial constriction or cardiac tamponade.Back to Top
Prevalence and risk factors
Heart failure is a common syndrome, especially in older adults. Although more patients surviveacute myocardial infarction because of reperfusion therapy, most have at least some residual leftventricular systolic dysfunction, which may lead to heart failure. Currently, 5 million Americansare afflicted with heart failure, approximately 2% of the population.
Patients with heart failureaccount for about 1 million hospital admissions annually, with another 2 million patients havingheart failure as a secondary diagnosis. One third of these patients are readmitted within 90 daysfor recurrent decompensation.Patients at high risk for developing heart failure are those with hypertension, coronary arterydisease, diabetes mellitus, familial history of cardiomyopathy, use of cardiotoxins, and obesity.Back to Top
Pathophysiology and natural history
Although much progress has been made in the treatment of heart failure, there is a high overallannual mortality (5% to 20%), particularly in patients with New York Heart Association(NYHA) Class IV symptoms.
Many patients succumb to progressive pump failure andcongestion, although one half die from sudden cardiac death. Some patients die from end-organfailure resulting from inadequate systemic organ perfusion, particularly to the kidneys. Indicators