1. HEART FAILURE (HF)
Heart failure is the pathophysiological state in which an abnormality of cardiac function is responsible for failure of the heart to pump blood at a rate commensurate with the requirements of the metabolizing tissue, or to do so only from an elevated filling pressure.
Clinical syndrome due to different structural and functional disease of the heart leading to abnormality in filling or emptying of the left ventricle.

2. Myocardial insufficiency – related to impaired contractility
Myocardial insufficiency – related to impaired contractility. Not every heart failure is associated with myocardial insufficiency.
Circulatory failure – clinical syndrome which is caused by abnormality of the following components of circulation, such as the heart, blood volume, Hb level, vessels.

3. PATHOPHYSIOLOGY OF HF

4. Early adaptive mechanisms
Frank-Starling mechanism
Activation of neurohormonal systems

5. NEUROHORMONAL MECHANISMS
Elevation of norepinephrine leading to increased contractility.
Activation of renin-angiotensin-aldosterone system (RAAS).
Activation of arginine-vasopressin system.
Activation of natriuretic peptides (ANP, BNP, CNP).
Elevation of endotheline.
Elevation of cytokines (TNF-α, IL-1β).
NO (NO synthethase –NOS1-3).
Elevation of oxidative stress in the myocardium.

6. LATE ADAPTIVE MECHANISMS
Left ventricular remodeling

7. Parallel arrangement of sarcomers
Pressure overload
Volume overload
↑ Systolic strain
↑ Diastolic strain
↑ Activation of extracellular and intracellular signals
Left ventricular remodeling
Parallel arrangement of sarcomers
Serial arrangement of sarcomers
Concentric hyperthrophy
Excentric hyperthrophy
Normal

8. Framingham criteria for HF
Major criteria
Paroxyzmal nocturnal dyspnoe
Neck-vein distension
Rales
Cardiomegaly
Acute pulmonary edema
S3 gallop
↑ venous pressure(16 cm H2O)
Hepatojugular reflux
Loss of weight > 4,5 kg during 5 days
Minor criteria
Ankle edema
Night cough
Dyspnoe on exertion
Hepatomegaly
Pleural effusion
Tachyaardia (>120/min.)

9. FORMS OF HF Right-sided vs left-sided HF Acute vs chronic HF
Low-output vs high-output HF
Systolic vs diastolic HF

10. Causes of HF
Pericardial disease (tamponade, constrictive pericarditis)
Valvular heart disease
Disease of the myocardium (dilated CMP)
Coronary heart disease
Arrhythmias (tachycardia-induced CMP)

12. Pharmacological treatment
Diuretics
Vasodilators
Positive inotropic agents (digitalis, beta-blockers, phosphodiesterase inhibitors, Ca-senzitisers)
Neurohormonal inhibitors (ACEI, ARB, beta-blockers)

13. Nonpharmacological treatment
Intraaortic balloon contrapulsation
Mechanical support
CRT
Transplantation