Talk:Heart failure

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Should we include information about congestive heart failure in animals (such as small dogs), and the treatment, etc.? -- siliconwafer 9/21/04


What exactly is meant by the word "Congestive" ... does that mean congested like my noes gets when I have a cold? Whats it congested with? -- (unsigned)

"Congestive" in this case means "distended with fluid". Your question implies that you think it's the heart that congested, but it's named because the heart is unable to pump efficiently enough to prevent fluid accumulation in other places, like the lungs or liver or peripheral tissue. So the "congestion" that gives the syndrome its name is found in the lungs or peripheral tissue, causing difficulty breathing or leg swelling. That being said, it's sort of an old-fashioned term, and the word "congestive" is mostly filler... one might just as well say "heart failure" in most instances. - Nunh-huh 06:26, 12 Feb 2005 (UTC)

Contents

[edit] Expansion!

This article could do with a WP:MCOTW nomination. It needs image support, more on radiology, myocardial myodynamics, underlying causes and mechanisms, the significance of a renal impairment in CCF etc etc. JFW | T@lk 10:58, 20 October 2005 (UTC)

[edit] Misuse

From the article: "The term heart failure is frequently misused, especially when given as cause of death: it is not synonymous with "cessation of heartbeat"."

So, is the term "congestive heart failure" ever given as a cause of death? Shawnc 21:16, 23 October 2005 (UTC)

Well, it is, but the actual mechanism of death would still be ventricular fibrillation, pulseless electrical activity etc. Congestive heart failure itself is extremely unpleasant and carries a fairly strinky prognosis, but is not synonymous with cardiac arrest. JFW | T@lk 22:19, 23 October 2005 (UTC)
I want to add on by saying ultimately death (of course excluding brain death where the heart is still working) is due to cardiopulmonary arrest, regardless of the cause. But doctors cannot claim this on the death certificate (as it would basically be futile for statistical purposes, like when the WHO gathers data). Hence the "cause of death" can be many things. In fact on the death certificate doctors have to give a contributory cause also, like hypertension or diabetes, etc. So basically, congestive heart failure can be a cause of death, but in this article it would be misleading to say that it is the actual pathophysiological cause of death. User:Emortio | T@lk —Preceding comment was added at 20:49, 30 May 2008 (UTC)
Actually because of the pulmonary edema, you'll die of hypoxic respiratory failure. At least in the state of California, you're required to list the proximal cause of death (v fib arrest, asystole, hypoxic-ischemic brain injury, hypoxic and/or hypercapnic respiratory failure, etc.) as well as the chain of events that lead to this cause (acute myocardial infarction, asphyxiation, congestive heart failure, exsanguination, etc. I think there are six lines on the death certificate from what I remember.) 22:53, 6 June 2008 (UTC) —Preceding unsigned comment added by 132.239.142.130 (talk)

[edit] Expansion

Maybe there could be more information on heart failure, like the difference between each type of heart failure (left, right, congestive), the symptoms involved, specific treatment given. Could be made so that profesionals can use the information to. 82.35.34.152 (talk · contribs)

Yes, there could indeed. Would you like to help? JFW | T@lk 22:17, 30 November 2005 (UTC)+

[edit] Dyspnea

Im a nursing student and I have found that in this article it is mentioned CHF causes SOB, however it doesnt outline the cause of the SOB in reation to CHF. ie: The pathophysiology behind the dyspnea

Pulmonary congestion and pulmonary edema. JFW | T@lk 10:41, 23 April 2006 (UTC)

[edit] PMI

The term PMI used in this article is a new one on me, and looking around on the internet (none of my books mention it), it seems to be the same as the apex beat - which is a more widespread term. I've therefore changed the wording in this article, created a page for PMI and re-directed it to apex beat.

Also, I've never heard of obesity causing heart failure by squashing the heart so I removed the phrase "In obesity cases, the heart is squashed by fat surrounding it, giving it too little room to beat" and changed the sentence to include coronary artery disease. The only common restricitive causes of CHF I can find are restricitive cardiomyopathies and pericardial disease, neither of which seem to be related to epicardial fat restricting beating. I found one case report of a woman with Pfeifer-Weber-Christian disease who did have some changes in the epicardial fat, but this wasn't the only pathology and I don't think it's really common enough to justify the statement. There is also adipositas cordis, but this is vanishingly rare and again doesn't warrant a generic sentence about all obese people.

If anyone thinks that this is wrong, please let me know. Cheers Iain Joncomelately 09:11, 5 July 2006 (UTC)

[edit] How do most of you rate the readability of the article?

I've just read through the article, hope fully to gain more of an insite into my Mum's condition. I'm sure the article is accurate to the nth degree - unfortunatly it may as well be written in a foreign language!

I'm told that the mark of a great author is someone who can take a complex, highly technical subject and present it in a way that's easy to understand to non-technical folks. I for one would be eternally grateful if someone with such an ability could attempt this with this article.

222.154.235.62 08:05, 4 August 2006 (UTC)

No need to be so forceful. Just state which terms are particularly unclear, and we can work something out. Experts often presume that their audience understand some of their jargon, which may explain the article's poor readability. JFW | T@lk 10:37, 21 August 2006 (UTC)

[edit] Glucose

High glucose in nondiabetic patients admitted with heart failure is predictive of poor outcome[1]. JFW | T@lk 10:37, 21 August 2006 (UTC) Duration of poor glycemic control in diabetes is proportional to ischemic burden in heart failure.--Lbeben (talk) 00:31, 28 November 2007 (UTC)

[edit] Pointing the Bone

I understand that people that die psychosomatically - from voodo, the "pointing the bone" of the Australian aboriginies, and people that "turn their face to the wall" in hospitals - the immediate cause of death is congestiove heart failure.

Is this true? Is it worth mentioning?

[edit] A hard topic to write about

This article has a lot of potential. Unfortunately, CHF is not only a big topic, but an extremely complex one. There are fellowships that focus on just heart failure and transplant cardiology.:-(

Anyway, just adding a reference that should be in the article. It basically says that women are more likely to have diastolic dysfunction and more comorbid conditions while men are more likely to have systolic dysfunction. Some day I may take a stab at a rewrite of the article...

Mendes LA, Davidoff R, Cupples LA, Ryan TJ, Jacobs AK. Congestive heart failure in patients with coronary artery disease: the gender paradox. Am Heart J. 1997 Aug;134(2 Pt 1):207-12. PMID 9313599

Ksheka 15:30, 4 November 2006 (UTC)

[edit] Cardiac Arrest

I just want to check something. In the article introduction, it is mentioned that heart failure is "not to be confused with...cardiac arrest, which is the cessation of normal cardiac function in the face of heart disease." However, is cardiac arrest only associated with heart disease? I was under the impression that cardiac arrest merely referred to cessation of heartbeat. Checking out cardiac arrest, I got "A cardiac arrest, or circulatory arrest, is the abrupt stop of normal circulation of the blood due to failure of the heart to contract effectively during systole." The article also mentions hypoxia and hypothermia as possible causes of cardiac arrest, neither of which are disease related. Could someone please clarify this?

Good call. I changed this in the top of the article. Ksheka 13:25, 28 November 2006 (UTC)

I would argue that [cardiac arrest] is probably an outdated term. What actually stops is meaningful propagation of the sinoatrial/atrioventricular tree and subsequent sympathetic outflow engaging biomolecular systole. Sinoatrial propagation as interpreted by the traditional electrocardiogram (EKG)affords an easily reproduced electrical signature of the living myocardium, heavily biased to systole. Silencing the sympathetic/forward/electrical perfusion of the heart implies a great diversity of differential etiologies and diagnoses. Once the electrical supply has been catastrophically compromised, biomolecular failure soon follows. In cardiac arrest, a new EKG is seen when the sinoatrial tree fails and gives an electrical signature of parasympathetic/backward/electrical control. Evidence of secondary electrical/parasympathetic control of the myocardium is seen as [agonal rhythm] and [ventricular fibrillation]. Once full arrest/cessation of electrical systole and and electrical diastole have occured, a flat line is observed on the EKG. --Lbeben (talk) 23:53, 27 November 2007 (UTC)

Sorry this reads as Original research.
  1. "biomolecular systole", no hits on Google and, far more importantly, none at PubMed
  2. What evidence is there that ventricular fibrillation is due to parasympathetic control? Surely a transplanted heart, which does not have any parasympathetic vagus innervation, may undergo VF ? David Ruben Talk 00:26, 28 November 2007 (UTC)

[edit] ICD's

Systematic review on ICD's, probably quite relevant here and a hot topic: http://www.annals.org/cgi/content/abstract/147/4/251 JFW | T@lk 23:49, 20 August 2007 (UTC)

[edit] Pathophysiology

Lbeben (talk · contribs) has been writing the pathophysiology section, with Davidruben (talk · contribs) making some important improvements. But when I read the new section, all that strikes me is that it essentially rehashes the list of causes already mentioned before (HF due to ischaemia, infiltration, cardiomyopathy etc). I'd much rather see a section that actually describes processes like cardiomyocyte metabolism in heart failure, ventricular remodeling etc etc. Apart from the Neubauer source, do we have other useful sources that could be used as a scaffold for this section? JFW | T@lk 08:31, 21 November 2007 (UTC)

Fully agree that optimal biomolecular performance of the myocardium is an important determinant of heart failure. Biomolecular determinants are probably proportional and secondary to (blood) ischemic burden. My peculiar concern is terminology in describing what heart failure actually means. Thankfully we are past terms such as [dropsy] in describing the pathophysiology in question. Specifying terms in an evolving text is a daunting but worthy endeavor, especially in the context of an online encylopedia. Best suggested starting point in this discourse is [Arthur Guyton, Textbook of Physiology].Lbeben (talk) 01:30, 22 November 2007 (UTC)

[edit] Proposal to delete Pathophysiology

Beg to differ, but lets start with "biomolecular performance of the myocardium", I promise you no cardiologist I have ever heard speak has used such tortuous language. I only can hazard a guess at "Biomolecular determinants are probably proportional and secondary to (blood) ischemic burden" (ponder on "biomolecular determinants", concept that proportional factors are not secondary to each other and finally can there be any non-blood ischemia) ? Finally Guyton as a medical textbook is not an appropriate starting point, as the level of description needs be comprehensible to high school students as well as to the average (non-medical) undergraduate – and Wikipedia is not a textbook.

This section does not differ from the list of causes already covered in the article, but instead seems an unstructured collection of points added in a manner that suggests WP:Synthesis of ideas (i.e. it is original research) and as such would be better deleted in its entirety. Whilst I have attempted previously to simplify the obtuse language used, the points remain unsupported by citation, e.g. "Heart failure can be can be considered as pathological degradation of Systole and Diastole.[citation needed]" not least that this is self-referential, warrants the clarity of the copyeditor's cutting of the Gordian Knot that its obfuscation deserves.

Therefore should we delete this section ? David Ruben Talk 00:38, 29 November 2007 (UTC)

I agree that in its present form, the section adds absolutely nothing to the article. It simply rehashes points already made elsewhere (e.g. valvular disease causing heart failure), and otherwise completely fails to systematically present the mechanism by which the heart fails. No word about ventricular remodeling, no word about what systolic and diastolic heart failure actually means and what the differences are... We need a much clearer approach, and I think deletion of the section is indeed warranted. JFW | T@lk 03:28, 29 November 2007 (UTC)
I agree as well. The present compilation lacks coherence and meaning. If we wipe the slate clean, how can a more lucid approach to an article about pathophysiology in heart failure be attempted? In my view a very flexible outline is required in elaborating the causes of heart failure and their relationships to one another. Understanding of degradation of systole and diastole lends itself to an attempt/articles of definition of systolic heart failure and diastolic heart failure.
In my opinion, mathematics that illuminate systole and diastole would be an excellent starting point readily appreciated within and outside the medical community. Inclusion of the medical physics community in this debate is suggested.
Cardiac output and ejection fraction are perhaps the best known and inexpensively imaged mathematical representations of systole. Simple inversion of these bedrock terms yields cardiac input and injection fraction, readily applied to diastole.
If a mathematical framework is agreed upon as a definitive construct of the outline of the article, other manifestations of failure can be added and edited as they are published. Examples would be pressure/volume relationships, blood mass and viable/nonviable myocardial mass, stress/strain/compliance, geometry/wall thickness and adaptive modeling, sympathetic and parasympathetic electrical perfusion of the myocardium, ATP/calcium, blood supply and ischemia, etc.
Our present grasp of pathophysiology in heart failure calls to mind the parable of a troupe of blind men examining an elephant and announcing what it is. A Wikipedia definition of the elephant demands cooperation and collaboration amongst many disciplines. If I can be of further service in preparing the proposed outline, please let me know.--Lbeben 03:12, 1 December 2007 (UTC)
Propose inclusion of work by [Torrent-Guasp] in the pathophysiolgy article.—Preceding unsigned comment added by Lbeben (talk • contribs) 06:14, 6 December 2007
I've completely overhauled this section! Agreed with you guys, the old one was a baffling mess and desperately needed a change, considering this is such a common and well-known disease. (By the way, I'm a 2nd year medical student and these are my own notes, so there could well be errors and it most likely isn't up to date with cutting-edge research. Its drawn from lecture notes and textbooks so I also haven't included any references, sorry. Feel free to make changes as needed :D ) Thebagman (talk) 00:03, 10 December 2007 (UTC)

[edit] Device Therapy in Heart Failure

Suggest inclusion of an article about devices that impart passive restraint of the myocardium as a means of addressing geometric degradation /pathophysiology in heart failure. Acorn Cardiovascular and Paracor Medical are the top two American companies in pursuit of this intellectual property. Their patents are open to the public on the US Patent and Trademark Office official web site and readily linked and quoted as references to the proposed article. --Lbeben (talk) 00:58, 12 December 2007 (UTC)

Take care with this, if they are "in pursuit of this" then this is under development &/or has not yet been used in clinical setting much, has yet to be evaluated by regulatory bodies, and therefore yet to be assessed by wider community of cardiologists. As such it therefore currently forms zero impact in the treatment of patients currently with heart failure and WP:UNDUE needs be considered, also are there yet independant reliable third-party sources to WP:Verify this as being WP:Notable or of significance (company's own claims or patent applications are generally not in themselves WP:RS). So probably too soon to make (any/much) mention of this yet :-) David Ruben Talk 02:23, 12 December 2007 (UTC)
Aye. Have you looked more into the mathematics behind what they are doing?--Lbeben (talk) 02:11, 13 December 2007 (UTC)

No, we should not be expected to "look into mathematics" to understand contributions to this article. If a treatment is experimental, I would not normally add it unless every single scientific review on the subject tauts it as "the next big thing". I'm not seeing that here. JFW | T@lk 08:09, 16 December 2007 (UTC)

[edit] Translation into Chinese Wikipedia

The 16:11, 15 December 2007 Thebagman version of this article is translated into Chinese Wikipedia.--Philopp (talk) 20:30, 16 December 2007 (UTC)

[edit] Moved from the article

Jlf64 (talk · contribs) added some content that needs sourcing and rephrasing before it can be readded:

Rate of hospitalization is approximately equal, however the prognosis for diastolic heart failure is better than systolic heart failure.
Annual mortality: Healthy people = 1%
Diastolic with CAD = 5% - 7%
Diastolic without CAD = 2% - 3%
Systolic = 10% - 15%
Complication rate is about the same regardless of type of heart failure
This is hard data without a source.
Diastolic and systolic failure have some variance also. Systolic failure has the following charateristics:
HF with reduced ejection fraction
Reduction in muscle mass
↓ contractility
dilated chamber
↑ cardiac volumes
↓ Left ventricular ejection fraction (LVEF < 40%)
Diastolic heart failure presents the following:
HF with preserved ejection fraction
Restriction of ventricular filling
Ventricular stiffness and hypertrophy
Impaired filling due to abnormal relaxation
Normal sized chamber, normal emptying, (LVEF > 40%)
Does not fall within the guidelines for ACE-1 or ARB
Less research has been done on this type of heart failure
Diastolic heart failure can often times lead to eventual systolic failure. Most research to date has been done on systolic heart failure treatment, therefore most treatment recommendations are directed toward systolic failure.
This is useful content (we previously did not distinguish between systolic and diastolic heart failure), but it addresses more the pathophysiological differences and hence should not be in the "signs and symptoms" section. Also, the bullet point presentation reads more like a medical student's lecture notes. JFW | T@lk 07:44, 3 January 2008 (UTC)

[edit] Chronic venous congestion

Would somebody take a look at Chronic venous congestion and Heart failure cells and deduce whether or not they merit their own articles, and/or should be referenced in this one? BigBlueFish (talk) 23:52, 6 May 2008 (UTC)

[edit] Prevention?

Since heart failure is a common early killer, it would be nice if a section on prevention could be included. Even though the article gives details of how HF should be treated (reduce weight, low salt etc) which gives some clues about prevention, it would be better if there was a specific section on prevention, even if there was little to say about it. (My guess is that high alcohol consumption may be one of the causes). 80.2.206.140 (talk) 11:23, 10 June 2008 (UTC)