Clinical meaning
Progressive HF triggers maladaptive neurohormonal cascades: RAAS activation increases sodium/water retention and afterload; SNS activation increases heart rate and contractility but also myocardial oxygen demand. Chronic ventricular wall stress activates matrix metalloproteinases that remodel the ventricle from elliptical to spherical, worsening function.
Diagnosis & workup
Diagnostics & workup: - Order BNP/NT-proBNP for diagnosis and trending - Order echocardiogram to assess EF and wall motion - Order chest X-ray for pulmonary congestion - Order iron studies (iron deficiency worsens HF) - Order thyroid function tests - Monitor daily weights and I&O - Order right heart catheterization for refractory cases
Risk factors: - Prior MI with reduced EF - Chronic uncontrolled hypertension - Valvular heart disease - Cardiotoxic chemotherapy exposure - Chronic alcohol use - Familial dilated cardiomyopathy - Diabetes with cardiomyopathy - Obstructive sleep apnea