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Chapter

55

Heart Failure: pathophysiology and Diagnosis

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The coronary vessels

in the right anterior oblique (A) and Ie[t anterior oblique (B) view
are shorvn. The major arteries are ihe lefi main. left anterior descend-

ing. circumflex, and right coronary arteries. (From \hng SS, Bentivogiio LG, Maranhao \ Goldberg H [eds]: From Cardiac Catheterization Data to Hemodl,namic Parameters.

Philadelphia: Oxford University

Press, 1988. Used by permission

of

Oxford University

Press,

Inc.)

fulure BilGctions
The carcliac catheterization laboratory o[ the future is likelv to incorporate new methods of, cardiac. imag-ing, real-time *rg*ri. r_esonance angiography, and.rhe imaging oI arheroscleroric p6qucs wrth magnetic resonance techniques.

SUGGESTED READING Amrican College oIcardiorogy./American HeartAssociation Ad Hoc Task Force on pracdcc Uurdellnes: AC( /A[lA gurdeli nes lor r oronary angiography. C i rcularion qq9.q9.2 I

21\ I . R(yiew

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oronam angiography and inditatiou

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ihe procedure.

o An example of a significant stenosis in rhe ]efr anterior descending coronary artery.

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with agens such

provide an estimate of coronary flow reserve and help assess the severity of the stenosis. A significant reduction in coronary flow reserve is present when the ratio of flow at. rest to flow after vasodilation is less than 2 : 1. Measurement of the
as adenosine can

pressure gradient across a stenosis using a small wire transducer also can assess functional severity. Fractional flow reserve is the ratio of the distal pressure to proximal pressure after maximum vasodilation. A fracdonal flowreserve of less than0.75 indicates asignificanr srenosis. Measurement of blood flow velocity and coronary artery diameter before and after administration of acetylcholine can assess the possibility that coronary vasospasm or abqormalities in coronary endothelial function are present. Intravascular ultrasound, fractional flow reserve, and Dopplir flow studies are used most commonly in conjunction with interventional procedures.

HMM ffilURT Ilelinition

ity of cardiac function is responsibte for the inability of the heart to
sures orvolumes. The heart failure syndrome is characterjzed by sisns and q,rnptoms of intravascular and interstitial volume overloai,

Heart failure is a heterogeneous syndrome in which an abnormal-

pumpblood at an output sufficient to meet the requirements of metab_ ollzlng tissues or to do so only at abnormally elevated diastolic pres-

ing shortness of breath, rales, and edema, andlor manifertriio.r, of

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