Chapter 12: Heart Failure

Heart failure is a clinical syndrome resulting from the heart’s inability to fill with or pump sufficient blood to meet the body’s needs. Heart failure can be caused by any disorder that affects cardiac systolic or diastolic function or both. Patients with an ejection fraction less than or equal to 40% are classified as having heart failure with reduced ejection fraction (HFrEF), whereas those with an ejection fraction of greater than or equal to 50% have heart failure with preserved ejection fraction (HFpEF). Compensatory mechanisms activate to help maintain adequate cardiac output; activation of those systems is responsible for heart failure symptoms and disease progression. Medications that improve patient outcomes antagonize those compensatory mechanisms. Patients should avoid drugs that can precipitate or worsen heart failure (e.g., nonsteroidal anti-inflammatory drugs [NSAIDs], verapamil, diltiazem, and others).