Towards defining heart failure in adults with congenital heart disease

Towards defining heart failure in adults with congenital heart disease Original Research Article Pages 15-23 Aidan P. Bolger, Michael A. Gatzoulis Close Close preview | Purchase PDF (271 K) | Related articles | Related reference work articles AbstractAbstract | Figures/TablesFigures/Tables | ReferencesReferences Abstract Injury to the myocardium disrupts geometric integrity and results in changes to intracardiac pressure, wall stress and tension, and the pattern of blood flow through the heart. Significant disruption to pump function results in heart failure which is defined in terms of symptoms: breathlessness and fatigue, signs of salt and water retention, and neurohormonal activation. This syndrome most commonly occurs in the context of injury due to ischaemic heart disease and dilated cardiomyopathy but because patients with congenital heart disease (CHD) are born with sometimes gross distortions of cardiac anatomy they too are subject to the forces that drive heart failure. This paper explores the available data relating to the clinical and neurohormonal manifestations of heart failure in patients with congenital heart disease and describes how, by additionally exploring events at a cellular level, we may be able to arrive at a definition of heart failure relevant to this population. Article Outline 1. The absence of heart failure: the normal adult heart 2. Heart failure: a deviation from the norm 3. Conventional diagnostic criteria of chronic heart failure 4. Adult congenital heart disease and heart failure diagnostic criteria 4.1. Symptoms of heart failure 4.2. Signs of heart failure 4.3. Cardiac dysfunction 4.4. Natriuretic peptides 5. Neurohormonal activation and other evidence of the heart failure phenotype 6. Future directions References