(p. 9) The physiology of patients with HF: the origin of symptoms and rationale for treatment 

Heart Failure is a syndrome of symptoms and signs such as dyspnoea, fatigue, pulmonary congestion and peripheral oedema in the context of objective evidence of structural and/or functional cardiac abnormalities at rest. Coronary artery disease is the most common cause in the Western world. Irrespective of aetiology the primary cardiac insult effects a reduction in stroke volume and a consequent fall in cardiac output which triggers numerous compensatory haemodynamic, neurohumoral and structural responses. Whilst initially effective in restoring and maintaining cardiac output, over time, these responses are maladaptive and contribute to adverse ventricular remodelling and a further decline in cardiac function. The predominant symptoms of chronic HF are dyspnoea, oedema, fatigue and pain. Treatment aims to alleviate symptoms and avoid hospital admissions whilst minimising disease progression and reducing mortality. The management of HF comprises both pharmacological and non-pharmacological therapies including implantable devices and surgical interventions.