Heart Failure ESC - HPS

Guidelines for the diagnosis and
treatment of acute and chronic heart

failure 2012
ESC
DEFINITION OF HEART FAILURE (HF)

an abnormality of cardiac structure or
function
leading to failure of the heart to deliver
oxygen
at a rate commensurate with the
requirements of the metabolizing tissues,
despite normal filling pressures
(or only at the expense of increased filling
pressures)
CLINICAL DEFINITION
a syndrome in which patients have
typical
symptoms (e.g. breathlessness, ankle
swelling, and fatigue) and
signs (e.g. elevated jugular venous
pressure, pulmonary crackles, and
displaced apex beat)
resulting from an abnormality of

cardiac structure or function
Many of the symptoms of HF are nondiscriminating

and, therefore, of limited diagnostic value.
Many of the signs of HF result from sodium and water
retention and resolve quickly with diuretic therapy, i.e.
may be absent in patients receiving such treatment.
Demonstration of an underlying cardiac cause is
therefore central to the diagnosis of HF.
This is usually myocardial disease causing systolic
ventricular dysfunction.
However, abnormalities of ventricular diastolic function or of
the valves, pericardium, endocardium, heart rhythm, and
conduction can also cause HF (and more than one
abnormality can be present)
Identification of the underlying

cardiac problem crucial for
therapeutic reasons,
precise pathology determines the
specific treatment used e.g.
valvular disease valve surgery
LV systolic dysfunction pharmacological
therapy
TERMINOLOGY
Terminology related to left ventricular
ejection fraction
Terminology related to the timecourse of heart failure
Terminology related to the
symptomatic severity of heart failure
Terminology related to the timecourse of heart failure

The terms used to describe different types of HF can
be confusing.
As described above, in these guidelines the term HF
is used to describe the symptomatic syndrome,
graded according to the New York Heart Association
(NYHA) functional classification (see Section 3.4 and
Table 2), although a patient can be rendered
asymptomatic by treatment.
In these guidelines, a patient who has never exhibited
the typical signs or symptoms of HF is described as
having asymptomatic LV systolic dysfunction (or
whatever the underlying cardiac abnormality is).
Patients who have had HF for some time are often said to have
chronic HF.
A treated patient with symptoms and signs, which have remained
generally unchanged for at least a month, is said to be stable.
If chronic stable HF deteriorates, the patient may be described as
decompensated and this may happen suddenly, i.e. acutely,
usually leading to hospital admission, an event of considerable
prognostic importance.
New (de novo) HF may present acutely, for example as a
consequence of acute myocardial infarction or in a subacute (gradual)
fashion, for example in a patient who has had asymptomatic cardiac
dysfunction, often for an indeterminate period, and may persist or
resolve (patients may become compensated).
Although symptoms and signs may resolve in the latter patients, their
underlying cardiac dysfunction may not, and they remain at risk of
recurrent decompensation.
Occasionally, however, a patient may have HF due to a problem that

resolves completely (e.g. acute viral myopericarditis).
Some other patients, particularly those with idiopathic dilated
cardiomyopathy, may also show substantial or even complete
recovery of LV systolic function with modern disease-modifying
therapy [including an angiotensin converting enzyme (ACE) inhibitor,
beta-blocker, and mineralocorticoid receptor antagonist (MRA)].
Congestive HF is a term that is sometimes still used, particularly
in the USA, and
may describe acute or chronic HF
with evidence of congestion (i.e. sodium and water retention).
Congestion, though not other symptoms of HF (e.g.fatigue), may

resolve with diuretic treatment. Many or all of these terms may be
accurately applied to the same patient at different times, depending
upon their stage of illness.

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Heart Failure ESC - HPS

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Guidelines for the diagnosis and

treatment of acute and chronic heart

DEFINITION OF HEART FAILURE (HF)

resulting from an abnormality of

Many of the symptoms of HF are nondiscriminating

Identification of the underlying

Terminology related to the timecourse of heart failure

Occasionally, however, a patient may have HF due to a problem that

Congestion, though not other symptoms of HF (e.g.fatigue), may

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