Contemporary Diagnosis and Management of Heart Failure [antikvár]

Chapter 1Pathophysiology of Heart FailureHeart failure has been recognized as a clinical syndrome since the ancient Egyptian and early Greek civihzations. However, despite our long-standing abiUty to identify the signs and symptoms of heart failure, the definitions used to describe this syndrome have evolved substantially over time. This progressive redefinition of heart failure is based on input from several sources. New insights have been made on the basis of observations made by astute clinicians, and results of chnical trials assessing new therapies have also helped support (or refute) various ideas about the causes of heart failure. The clinical database has been complemented and often stimulated by mechanistic and therapeutic studies in experimental animal models and by basic laboratory work that has unraveled many of the ceUular processes and pathways that He at the roots of this syndrome. Most recently, our understanding of the basis of heart failure has been extended by insights gained using the techniques of molecular biology and by the pioneering work of defining Üie human genome.The continued evolution of our understanding of heart failure pathophysiology has resulted in a succession of paradigms to describe this syndrome. Figure 1 depicts the paradigms that have been used over the past 50 years. These paradigms help us clinically because they providel^ii M I M'r 'iVirlWi-'ii:'!' I I .