I. Incidence and Pathogenesis
II. Basic Causes of Heart Failure
III. Precipitating Factors
IV. Pathophysiology
V. Symptoms and Signs
VI. Diagnosis
VII. Drug Treatment
VIII. Nondrug Therapy
IX. What to Expect in the Hospital and on Discharge

GLOSSARY
cardiomyopathy heart muscle disease.
ejection fraction the fraction of blood ejected from the heart into the arteries, normally this ranges from 50 to 75%; a low ejection fraction is less than 45%; often used as a marker of ventricular contractility.
inotropic an effect that affects the force of muscular contrac¬tions; negative inotropic refers to decreased myocardial con¬tractility that may lead to poor pumping of blood, reduced ejection fraction, and heart failure.
myocardial infarction death of an area of heart muscle due to blockage of a coronary artery by blood clot and atheroma; medical term for heart attack or coronary thrombosis.
THE WORLD FACES AN EPIDEMIC OF HEART failure. This condition, unlike coronary artery disease, has no territorial boundaries (see Tables 1 and 2 in the chapter Angina for worldwide statistics). Heart failure is common both in developed and developing countries. In the United States more Medicare dollars are spent on the management of heart failure than for any other diagnosis. The cost worldwide is astronomic.

• I. INCIDENCE AND PATHOGENESIS
  Heart failure is present when the heart is unable to eject enough blood from its chambers into the circulation to satisfy the needs of the body. Heart failure is responsible for over one million admissions to hospitals in the United States.
• II. BASIC CAUSES OF HEART FAILURE
  A. Coronary Artery Disease
• III. PRECIPITATING FACTORS
  In addition to problems in the heart and with high blood pressure, there are several factors that precipitate heart failure when the muscle is weakened. These conditions must be avoided or treated. Problems that can precipitate heart failure in patients with a weak heart muscle or diseased valve include the patient–physician problems listed below.
• IV. PATHOPHYSIOLOGY
  A. Nature’s Defense Mechanisms
• V. SYMPTOMS AND SIGNS
  A. Symptoms
• VI. DIAGNOSIS
  A. Chest X-Ray
• VII. DRUG TREATMENT
  A. Digitalis (Digoxin)
• VIII. NONDRUG THERAPY
  A. Advice on Drugs, Salt, Diet, Potassium, Alcohol, and Exercise
• IX. WHAT TO EXPECT IN THE HOSPITAL AND ON DISCHARGE
  The main symptom of heart failure is severe shortness of breath. Pain occurs only when heart failure is precipitated by a heart attack. If nitroglycerin is available, put one under the tongue and remain propped up in bed or sit until the ambulance arrives.
• BIBLIOGRAPHY
  Abraham, W. T., Fisher, W. G., Smith, A. L. et al. Cardiac resynchronization in chronic heart failure. N. Engl. J. Med., 346:1845–53, 2002.