Description
Heart failure has been rightly said to re p resent the cardiologist’s greatest challenge. Whilst it is the final common path way of numerous diseases of the heart, heart failure is a complex syndrome that has been the subject of an enormous body of research at all levels – from molecular biology to population studies and from pathophysiology through clinical assessment to medical, surgical and other treatments.
The present issue of CME Cardiology is specially focused on the topic of heart failure. In our first article, Ashrafian and I review current understanding of the pathophysiology of heart failure, viewed from the perspectives of organ system dysfunction, contractile dysfunction of the heart and of cellular energetics. After this, there are a series of evidence – based reviews – of the clinical assessment of the patient, special
investigations, particularly echo, nuclear and magnetic resonance imaging and medical management as directed by clinical trials.</p>
The clinical setting in which patients are assessed, investigated, advised and treated is the subject of much current discussion and the
development of rapid access heart failure clinics, often led by specialist nurse practitioners is starting to take off. Fox describes his own
experience in setting up such a service within a wider review.
The range of surgical options has expanded greatly, as described by Pepper and Chambers. Recently, the recognition that many poor ventricles are mechanically inefficient because of dyscoordinate contraction has led to the implantation of pacemaker systems to ‘resynchronise’ cardiac contraction, often with dramatic effect. Kaprelian and Lefroy consider the range of electrical options in heart failure.
Unfortunately, despite our best endeavours, many of our patients with heart failure will eventually enter a terminal phase. We cardiologists have
for too long ignored the fact that these patients require professional palliation. Beattie presents a powerful case for such a service.
If this edition of CME contributes to informing physicians about heart failure and supporting their continuing professional development and
revalidation, it will have fully achieved its purpose .
