Approach to the Patient with Heart Failure

Heart failure is a complex clinical syndrome resulting from structural and functional impairment of ventricular filling or ejection of blood. The clinical syndrome of heart failure may arise due to abnormalities involving all aspects of cardiac structure and function, but most patients have impairment of myocardial function, which may range from normal ventricular size and function to marked ventricular dilation and reduce function. The approach to the patient with suspected or proven heart failure includes an understanding of the epidemiology of the diagnosis, its risk factors, and how to classify it. History and physical examination are the cornerstone for the assessment of heart failure and are supported by routine laboratory assessment including imaging, the electrocardiogram, measurement of blood chemistry and hematologic variables along with echocardiographic imaging. In certain circumstances other modalities such as cardiac magnetic resonance imaging, cardiac computerized tomography, right and left heart catheterization, endomyocardial biopsy, and cardiopulmonary exercise testing may be necessary in the course of evaluation of affected patients.