Talk:Heart failure/Archive 1

Expansion!
This article could do with a WP:MCOTW nomination. It needs image support, more on radiology, myocardial myodynamics, underlying causes and mechanisms, the significance of a renal impairment in CCF etc etc. JFW | T@lk  10:58, 20 October 2005 (UTC)

Expansion
Maybe there could be more information on heart failure, like the difference between each type of heart failure (left, right, congestive), the symptoms involved, specific treatment given. Could be made so that profesionals can use the information to.


 * Yes, there could indeed. Would you like to help? JFW | T@lk  22:17, 30 November 2005 (UTC)+

Dyspnea
Im a nursing student and I have found that in this article it is mentioned CHF causes SOB, however it doesnt outline the cause of the SOB in reation to CHF. ie: The pathophysiology behind the dyspnea


 * Pulmonary congestion and pulmonary edema. JFW | T@lk  10:41, 23 April 2006 (UTC)

How do most of you rate the readability of the article?
I've just read through the article, hope fully to gain more of an insite into my Mum's condition. I'm sure the article is accurate to the nth degree - unfortunatly it may as well be written in a foreign language!

I'm told that the mark of a great author is someone who can take a complex, highly technical subject and present it in a way that's easy to understand to non-technical folks. I for one would be eternally grateful if someone with such an ability could attempt this with this article.

222.154.235.62 08:05, 4 August 2006 (UTC)


 * No need to be so forceful. Just state which terms are particularly unclear, and we can work something out. Experts often presume that their audience understand some of their jargon, which may explain the article's poor readability. JFW | T@lk  10:37, 21 August 2006 (UTC)

A hard topic to write about
This article has a lot of potential. Unfortunately, CHF is not only a big topic, but an extremely complex one. There are fellowships that focus on just heart failure and transplant cardiology.:-(

Anyway, just adding a reference that should be in the article. It basically says that women are more likely to have diastolic dysfunction and more comorbid conditions while men are more likely to have systolic dysfunction. Some day I may take a stab at a rewrite of the article...

Mendes LA, Davidoff R, Cupples LA, Ryan TJ, Jacobs AK. Congestive heart failure in patients with coronary artery disease: the gender paradox. Am Heart J. 1997 Aug;134(2 Pt 1):207-12.

Ksheka 15:30, 4 November 2006 (UTC)

ICD's
Systematic review on ICD's, probably quite relevant here and a hot topic: http://www.annals.org/cgi/content/abstract/147/4/251 JFW | T@lk  23:49, 20 August 2007 (UTC)

Cardiac Arrest
I just want to check something. In the article introduction, it is mentioned that heart failure is "not to be confused with...cardiac arrest, which is the cessation of normal cardiac function in the face of heart disease." However, is cardiac arrest only associated with heart disease? I was under the impression that cardiac arrest merely referred to cessation of heartbeat. Checking out cardiac arrest, I got "A cardiac arrest, or circulatory arrest, is the abrupt stop of normal circulation of the blood due to failure of the heart to contract effectively during systole." The article also mentions hypoxia and hypothermia as possible causes of cardiac arrest, neither of which are disease related. Could someone please clarify this?
 * Good call. I changed this in the top of the article. Ksheka 13:25, 28 November 2006 (UTC)

I would argue that [cardiac arrest] is probably an outdated term. What actually stops is meaningful propagation of the sinoatrial/atrioventricular tree and subsequent sympathetic outflow engaging biomolecular systole. Sinoatrial propagation as interpreted by the traditional electrocardiogram (EKG)affords an easily reproduced electrical signature of the living myocardium, heavily biased to systole. Silencing the sympathetic/forward/electrical perfusion of the heart implies a great diversity of differential etiologies and diagnoses. Once the electrical supply has been catastrophically compromised, biomolecular failure soon follows. In cardiac arrest, a new EKG is seen when the sinoatrial tree fails and gives an electrical signature of parasympathetic/backward/electrical control. Evidence of secondary electrical/parasympathetic control of the myocardium is seen as [agonal rhythm] and [ventricular fibrillation]. Once full arrest/cessation of electrical systole and and electrical diastole have occured, a flat line is observed on the EKG. --Lbeben (talk) 23:53, 27 November 2007 (UTC)
 * Sorry this reads as Original research.
 * "biomolecular systole", no hits on Google and, far more importantly, none at PubMed
 * What evidence is there that ventricular fibrillation is due to parasympathetic control? Surely a transplanted heart, which does not have any parasympathetic vagus innervation, may undergo VF ? David Ruben Talk 00:26, 28 November 2007 (UTC)

Glucose
High glucose in nondiabetic patients admitted with heart failure is predictive of poor outcome. JFW | T@lk  10:37, 21 August 2006 (UTC) Duration of poor glycemic control in diabetes is proportional to ischemic burden in heart failure.--Lbeben (talk) 00:31, 28 November 2007 (UTC)

Pathophysiology
has been writing the pathophysiology section, with making some important improvements. But when I read the new section, all that strikes me is that it essentially rehashes the list of causes already mentioned before (HF due to ischaemia, infiltration, cardiomyopathy etc). I'd much rather see a section that actually describes processes like cardiomyocyte metabolism in heart failure, ventricular remodeling etc etc. Apart from the Neubauer source, do we have other useful sources that could be used as a scaffold for this section? JFW | T@lk  08:31, 21 November 2007 (UTC)

Fully agree that optimal biomolecular performance of the myocardium is an important determinant of heart failure. Biomolecular determinants are probably proportional and secondary to (blood) ischemic burden. My peculiar concern is terminology in describing what heart failure actually means. Thankfully we are past terms such as [dropsy] in describing the pathophysiology in question. Specifying terms in an evolving text is a daunting but worthy endeavor, especially in the context of an online encylopedia. Best suggested starting point in this discourse is [Arthur Guyton, Textbook of Physiology].Lbeben (talk) 01:30, 22 November 2007 (UTC)

Proposal to delete Pathophysiology
Beg to differ, but lets start with "biomolecular performance of the myocardium", I promise you no cardiologist I have ever heard speak has used such tortuous language. I only can hazard a guess at "Biomolecular determinants are probably proportional and secondary to (blood) ischemic burden" (ponder on "biomolecular determinants", concept that proportional factors are not secondary to each other and finally can there be any non-blood ischemia) ? Finally Guyton as a medical textbook is not an appropriate starting point, as the level of description needs be comprehensible to high school students as well as to the average (non-medical) undergraduate – and Wikipedia is not a textbook.

This section does not differ from the list of causes already covered in the article, but instead seems an unstructured collection of points added in a manner that suggests WP:Synthesis of ideas (i.e. it is original research) and as such would be better deleted in its entirety. Whilst I have attempted previously to simplify the obtuse language used, the points remain unsupported by citation, e.g. "Heart failure can be can be considered as pathological degradation of Systole and Diastole.[citation needed]" not least that this is self-referential, warrants the clarity of the copyeditor's cutting of the Gordian Knot that its obfuscation deserves.

Therefore should we delete this section ? David Ruben Talk 00:38, 29 November 2007 (UTC)


 * I agree that in its present form, the section adds absolutely nothing to the article. It simply rehashes points already made elsewhere (e.g. valvular disease causing heart failure), and otherwise completely fails to systematically present the mechanism by which the heart fails. No word about ventricular remodeling, no word about what systolic and diastolic heart failure actually means and what the differences are... We need a much clearer approach, and I think deletion of the section is indeed warranted. JFW | T@lk  03:28, 29 November 2007 (UTC)


 * I agree as well. The present compilation lacks coherence and meaning. If we wipe the slate clean, how can a more lucid approach to an article about pathophysiology in heart failure be attempted? In my view a very flexible outline is required in elaborating the causes of heart failure and their relationships to one another. Understanding of degradation of systole and diastole lends itself to an attempt/articles of definition of systolic heart failure and diastolic heart failure.
 * In my opinion, mathematics that illuminate systole and diastole would be an excellent starting point readily appreciated within and outside the medical community. Inclusion of the medical physics community in this debate is suggested.
 * Cardiac output and ejection fraction are perhaps the best known and inexpensively imaged mathematical representations of systole. Simple inversion of these bedrock terms yields cardiac input and injection fraction, readily applied to diastole.
 * If a mathematical framework is agreed upon as a definitive construct of the outline of the article, other manifestations of failure can be added and edited as they are published. Examples would be pressure/volume relationships, blood mass and viable/nonviable myocardial mass, stress/strain/compliance, geometry/wall thickness and adaptive modeling, sympathetic and parasympathetic electrical perfusion of the myocardium, ATP/calcium, blood supply and ischemia, etc.
 * Our present grasp of pathophysiology in heart failure calls to mind the parable of a troupe of blind men examining an elephant and announcing what it is. A Wikipedia definition of the elephant demands cooperation and collaboration amongst many disciplines. If I can be of further service in preparing the proposed outline, please let me know.--Lbeben 03:12, 1 December 2007 (UTC)
 * Propose inclusion of work by [Torrent-Guasp] in the pathophysiolgy article. —Preceding unsigned comment added by Lbeben (talk • contribs) 06:14, 6 December 2007


 * I've completely overhauled this section! Agreed with you guys, the old one was a baffling mess and desperately needed a change, considering this is such a common and well-known disease. (By the way, I'm a 2nd year medical student and these are my own notes, so there could well be errors and it most likely isn't up to date with cutting-edge research. Its drawn from lecture notes and textbooks so I also haven't included any references, sorry. Feel free to make changes as needed :D ) Thebagman (talk) 00:03, 10 December 2007 (UTC)

Device Therapy in Heart Failure
Suggest inclusion of an article about devices that impart passive restraint of the myocardium as a means of addressing geometric degradation /pathophysiology in heart failure. Acorn Cardiovascular and Paracor Medical are the top two American companies in pursuit of this intellectual property. Their patents are open to the public on the US Patent and Trademark Office official web site and readily linked and quoted as references to the proposed article. --Lbeben (talk) 00:58, 12 December 2007 (UTC)


 * Take care with this, if they are "in pursuit of this" then this is under development &/or has not yet been used in clinical setting much, has yet to be evaluated by regulatory bodies, and therefore yet to be assessed by wider community of cardiologists. As such it therefore currently forms zero impact in the treatment of patients currently with heart failure and WP:UNDUE needs be considered, also are there yet independant reliable third-party sources to WP:Verify this as being WP:Notable or of significance (company's own claims or patent applications are generally not in themselves WP:RS). So probably too soon to make (any/much) mention of this yet :-) David Ruben Talk 02:23, 12 December 2007 (UTC)


 * Aye. Have you looked more into the mathematics behind what they are doing?--Lbeben (talk) 02:11, 13 December 2007 (UTC)

No, we should not be expected to "look into mathematics" to understand contributions to this article. If a treatment is experimental, I would not normally add it unless every single scientific review on the subject tauts it as "the next big thing". I'm not seeing that here. JFW | T@lk  08:09, 16 December 2007 (UTC)

Translation into Chinese Wikipedia
The 16:11, 15 December 2007 Thebagman version of this article is translated into Chinese Wikipedia.--Philopp (talk) 20:30, 16 December 2007 (UTC)

Moved from the article
added some content that needs sourcing and rephrasing before it can be readded:


 * Rate of hospitalization is approximately equal, however the prognosis for diastolic heart failure is better than systolic heart failure.
 * Annual mortality: Healthy people = 1%
 * Diastolic with CAD = 5% - 7%
 * Diastolic without CAD = 2% - 3%
 * Systolic = 10% - 15%
 * Complication rate is about the same regardless of type of heart failure


 * This is hard data without a source.


 * Diastolic and systolic failure have some variance also. Systolic failure has the following charateristics:
 * HF with reduced ejection fraction
 * Reduction in muscle mass
 * ↓ contractility
 * dilated chamber
 * ↑ cardiac volumes
 * ↓ Left ventricular ejection fraction (LVEF < 40%)


 * Diastolic heart failure presents the following:


 * HF with preserved ejection fraction
 * Restriction of ventricular filling
 * Ventricular stiffness and hypertrophy
 * Impaired filling due to abnormal relaxation
 * Normal sized chamber, normal emptying, (LVEF > 40%)
 * Does not fall within the guidelines for ACE-1 or ARB
 * Less research has been done on this type of heart failure


 * Diastolic heart failure can often times lead to eventual systolic failure. Most research to date has been done on systolic heart failure treatment, therefore most treatment recommendations are directed toward systolic failure.


 * This is useful content (we previously did not distinguish between systolic and diastolic heart failure), but it addresses more the pathophysiological differences and hence should not be in the "signs and symptoms" section. Also, the bullet point presentation reads more like a medical student's lecture notes. JFW | T@lk  07:44, 3 January 2008 (UTC)

Chronic venous congestion
Would somebody take a look at Chronic venous congestion and Heart failure cells and deduce whether or not they merit their own articles, and/or should be referenced in this one? BigBlueFish (talk) 23:52, 6 May 2008 (UTC)

Prevention?
Since heart failure is a common early killer, it would be nice if a section on prevention could be included. Even though the article gives details of how HF should be treated (reduce weight, low salt etc) which gives some clues about prevention, it would be better if there was a specific section on prevention, even if there was little to say about it. (My guess is that high alcohol consumption may be one of the causes). 80.2.206.140 (talk) 11:23, 10 June 2008 (UTC)


 * A large number of causes is listed. The only real way to prevent heart failure is treating these conditions - antihypertensives for high blood pressure, cutting down for alcoholics... In a sense, heart failure is prevented by ACE inhibitors after myocardial infarction. JFW | T@lk  11:55, 25 June 2008 (UTC)

CFS/ME
added that heart failure could be caused by chronic fatigue syndrome. The source, however, doesn't reflect this. Rather, it states that CFS/ME has the same impact on quality of life as heart failure. JFW | T@lk  11:58, 25 June 2008 (UTC)

PMI
The term PMI used in this article is a new one on me, and looking around on the internet (none of my books mention it), it seems to be the same as the apex beat - which is a more widespread term. I've therefore changed the wording in this article, created a page for PMI and re-directed it to apex beat.

Also, I've never heard of obesity causing heart failure by squashing the heart so I removed the phrase "In obesity cases, the heart is squashed by fat surrounding it, giving it too little room to beat" and changed the sentence to include coronary artery disease. The only common restricitive causes of CHF I can find are restricitive cardiomyopathies and pericardial disease, neither of which seem to be related to epicardial fat restricting beating. I found one case report of a woman with Pfeifer-Weber-Christian disease who did have some changes in the epicardial fat, but this wasn't the only pathology and I don't think it's really common enough to justify the statement. There is also adipositas cordis, but this is vanishingly rare and again doesn't warrant a generic sentence about all obese people.

If anyone thinks that this is wrong, please let me know. Cheers Iain Joncomelately 09:11, 5 July 2006 (UTC)

I agree entirely with you on the obesity issue. PMI stands for Point of Maximal Intensity, and is used (by me anyway) mainly when talking about auscultating the heart. In a normal heart then this is going to more or less correspond with the apex beat, but when murmurs are present it can be used to describe the point at which the murmur is heard loudest. Alsiola vet (talk) 05:18, 12 July 2008 (UTC)

Readmissions
Hard to predict: http://archinte.ama-assn.org/cgi/content/abstract/168/13/1371 JFW | T@lk  06:56, 15 July 2008 (UTC)

Hyponatremia
I'd like to expand on the Hyponatremia section - often overlooked - this accounts some 25.3% of patients admitted with heart failure have this condition on admission (OPTIMIZE-HF trial) - resulting in increased in-hospital and post-discharge mortality. There is a new paper which discusses treatment options, as there are no guidelines for treatment in heart failure settings. Melharmcc (talk) 14:03, 1 September 2008 (UTC)


 * With recent results on the vaptans this is definitely worth discussing in a few lines. Have you a recent reliable source for such a section? JFW | T@lk  22:50, 1 September 2008 (UTC)

Collaboration of the Week: Readability, and other meanderings.
Heart Failure seems to be very poorly understood in the general patient population, and I think we have to be careful to make this an accessible / readable article, remembering that Wikipedia is not a textbook. The header and terminology section need to be particularly simple.

I'm planning to make some edits over the next couple of days, but make the following suggestions for Collaboration & discussion:
 * dividing signs and symptoms into left and right is not particularly physiological - ie. peripheral oedema (classically regarded as "right heart backward failure") is usually the result of poorly perfused carotid receptors triggering ADH, and poorly perfused kidneys triggering the renin angiotensin system (ie. left ventricular forward failure).
 * dividing causes into left and right makes very little sense for the same reason... I would favour pressure load vs. volume load, or even valves/myocardium/peripheral circulation.
 * Treatment needs to be primarily changed into managing Acute decompensation, and managing Chronic disease.
 * The difference between drugs which impact on mortality (Alpha blockers + nitrates, ACE inhibitors, Angiotensin blockers, certain Beta Blockers, Aldosterone antagonists) and those that don't (everything else I'm afraid) needs to be emphasised.
 * The section on cardiopulmonary exercise testing should probably be merged with the cardiac transplantation/surgery section, because the vast majority of patients with HF won't get a transplant OR a cardiopulmonary stress test.
 * Substantial overall simplification needs to occur to improve readability.TamePhysician (talk) 03:48, 6 September 2008 (UTC)


 * I totally agree that education is vital and that many patients seem unaware what heart failure is, why they've got it, what their treatments are meant to achieve, and that it's a progressive condition. Could I suggest that you implement the changes you have recommended? JFW | T@lk  06:19, 7 September 2008 (UTC)


 * Thanks JFW, I'm underway with it, but plenty more to do.TamePhysician (talk) 11:37, 7 September 2008 (UTC)


 * In terms of readability, you might keep in mind the following:


 * I heard one of the prize winners, Professor Jacob, forewarn an audience of specialists more or less as follows: «In describing genetic mechanisms, there is a choice between being inexact and incomprehensible». In making this presentation, I shall try to be as inexact as conscience permits.


 * My own experience is that, in talking to patients, I am always surprised at how much difficulty they have with technical terms that are quite familiar to me. For that reason, I always use non-technical terms as much as possible, although I also include the technical terms so readers will get to learn them. Nbauman (talk) 22:25, 7 September 2008 (UTC)

Nitro
No mention was made of nitroglycerin in the management of CHF.

Will work on the acute treatment section. Have found an excellent guideline.

http://www.guideline.gov/summary/summary.aspx?doc_id=9328

Doc James (talk) 17:19, 17 September 2008 (UTC)


 * Yes, that and CPAP. JFW | T@lk  19:42, 17 September 2008 (UTC)

Observation
Observation: I have CHF and never had the "lighting bolt to the chest" pain, or really any other indication at all that there was anything seriously wrong with me. I went to a minor emergency clinic to see about my feet/legs swelling up, mainly because family members said "you look bad, see your doctor" and kept pestering me about it. After four hours in the clinic, they hooked me up to EKG - five minutes after that, I was in an ambulance on the way to the emergency room. Had I been aware of what a serious symptom swelling legs was, I would have gone three days earlier. Sorry if this doesn't belong here! —Preceding unsigned comment added by 66.142.93.50 (talk) 17:33, 23 December 2008 (UTC)


 * Leg swelling alone can have numerous causes. You didn't tell us what the EKG showed. JFW | T@lk  20:55, 23 December 2008 (UTC)


 * Sorry, I don't really know what the EKG showed. I saw it, and noticed that the up ticks looked kind of "mushy" and the down ticks were weak and very long but not present after every uptick. I'll ask next time I see the Doc. I guess my point is just that - swelling legs didn't seem all that important. Thinking back, I was a little bit out of breath, but not gasping for air or anything.

Heart failure guidelines
Someone created Image:Chronic Heart Failure.jpg and added it to the article. I reverted this change because I think images like this, containing mainly text, are difficult to edit by others and add little to the article. Furthermore, I'm concerned that part of the image contains copyrighted materials. Please comment. --Steven Fruitsmaak (Reply) 18:39, 4 February 2009 (UTC)

Xray of CHF
We need an X-ray of CHF. Currently the one we have is poor. Will try to get one if no one else has one easily available. Doc James (talk · contribs · email) 20:35, 2 November 2009 (UTC)

Pulmonary failure = heart failure
Can I get an explanation here please... I am confused, since doesn't "pulmonary failure" literally mean "lung failure"? Why then redirect or is this specific term used for something else. It is just confusing me, thanks. —Preceding unsigned comment added by Neikius (talk • contribs) 22:25, 11 April 2010 (UTC)


 * You were correct. I have redirected [pulmonary failure]] to respiratory failure, as they are for all intents and purposes identical. JFW | T@lk  21:32, 14 April 2010 (UTC)

poor writing in this article
"Acute decompensated heart failure is a term used to describe exacerbated or decompensated heart failure, referring to episodes in which a patient can be characterized as having a change in heart failure signs and symptoms resulting in a need for urgent therapy or hospitalization" This sentence is a very wordy way of saying pretty much nothing (lots of words and little content). This is just one example from the article... Much of this article may need a rewrite... --159.178.247.147 (talk) 12:38, 5 November 2010 (UTC)


 * sofixit JFW | T@lk  00:21, 8 November 2010 (UTC)

Prevalence
The following sentence makes no sense: "In developed countries, around 2% of adults suffer from heart failure, but in those over the age of 65, this increases to 6–10%." Is this per year, per decade, per lifetime, or what? 209.6.251.20 (talk) 11:49, 16 February 2011 (UTC)


 * It makes perfect sense, but it would help to add the word "prevalence". This means that at any point, 2% of the entire population have symptoms of heart failure. The lifetime risk will be roughly similar. Given that it is a chronic condition, the incidence will be much lower. JFW &#124; T@lk  20:32, 16 February 2011 (UTC)

What is meant by "congestive"
What exactly is meant by the word "Congestive" ... does that mean congested like my noes gets when I have a cold? Whats it congested with? -- (unsigned)


 * "Congestive" in this case means "distended with fluid". Your question implies that you think it's the heart that congested, but it's named because the heart is unable to pump efficiently enough to prevent fluid accumulation in other places, like the lungs or liver or peripheral tissue. So the "congestion" that gives the syndrome its name is found in the lungs or peripheral tissue, causing difficulty breathing or leg swelling. That being said, it's sort of an old-fashioned term, and the word "congestive" is mostly filler... one might just as well say "heart failure" in most instances. - Nunh-huh 06:26, 12 Feb 2005 (UTC)


 * I agree completely and wish to add that the misconception comes from the commonly used term congestive heart diseasewhich in context "congestive" means dilated. Congestive heart disease has its own list of syndromes altogether with most, commonly called congestive cardiomyopathy as a general medical condition.

--RichNelson (talk) 17:53, 28 May 2011 (UTC)

Right heart failure
I have a simple question about right-heart failure: what happens to the heart itself? The blood "backup" causes lower-extremity edema, ascites, jugular venous distension, etc. It would stand to reason that the right ventricle would hypertrophy. What about the left atrium? Will it also increase in size, due to the fluid overload?Dryphi (talk) 04:24, 8 August 2011 (UTC)

apparent self-contradiction in lead section
The following passage in the lead section seems to contradict itself:"Common causes of heart failure include myocardial infarction and other forms of ischemic heart disease, hypertension, valvular heart disease, and cardiomyopathy. The term "heart failure" is sometimes incorrectly used to describe other cardiac-related illnesses, such as myocardial infarction (heart attack) or cardiac arrest." The first sentence says that heart failure includes myocardial infarction, and then the following sentence says that is incorrect. Only one of those statements can be true.

If I am misreading this passage, and if by some subtlety that I am missing the two statements do not in fact contradict each other, then their true meaning needs to be made plainer so that readers like me will not see any contradiction. And if this issue is made clear later in the article (which I have not read, but which many other readers also will not read), then this part of the lead section needs to be changed to summarize the article better.--Jim10701 (talk) 15:07, 28 July 2011 (UTC)


 * You are indeed misreading it. Why is this unclear? Myocardial infarction can cause heart failure, but it is not equivalent to heart failure. Hope this is clear - if you have any ideas on how to rephrase this please let us know. JFW &#124; T@lk  15:18, 28 July 2011 (UTC)


 * Your explanation is perfect. The solution is to add it to the article, which I will do now.--Jim10701 (talk) 14:38, 10 August 2011 (UTC)

Acute heart failure
I am thinking that acute uncompensated heart failure needs its own page. Will work on this. Doc James (talk) 14:57, 6 December 2008 (UTC)

Wondering if we should change the name of this page to contrast it with acute heart failure?


 * Probably not. See Heart_failure. "Heart failure" is a very general term, and we can't cover all the details of all the causes on a single page. Instead, we should use this page to guide the reader to more detailed pages about the more specific causes of heart failure. Accordingly, we should probably reduce the content in the Heart_failure section, because different causes of heart failure would be treated in very different ways. --Arcadian (talk) 18:12, 6 December 2008 (UTC)


 * I would certainly support splitting in Treatment of acute heart failure and Treatment of chronic heart failure. But a general article on heart failure is surely necessary. --Steven Fruitsmaak (Reply) 18:39, 6 December 2008 (UTC)

The problem is that acute cardiac decompensation is quite different from chronic heart failure, although there is usually underlying [chronic] heart failure. I am not actually opposed to James' creation of acute decompensated heart failure, although we must also cover "non-cardiac" pathologies such as pulmonary embolism and fluid overload. JFW | T@lk  21:35, 6 December 2008 (UTC)

I've heard pericardial tamponade can cause the acute heart failure. If we have a section on chronic heart failure, shouldn't there be one on acute heart failure? I think there may be some confusion between acute heart failure and acute decompensated heart failure. Td1wk (talk) 19:58, 12 May 2012 (UTC)

We need a new name for this disease
Most people think "X failure" means X stopped working. I know several geezers with heart failure who are still ticking along; I see two at the gym twice a week.

Something along the lines of "cardiac insufficiency" or "ejection insufficiency"; sometimes tagged "with edema". Unless, of course, these terms have already been co-opted for other conditions. (I have no medical training.) Or even a totally new word, to avoid clumsy phrases.

I know Wikipedia is not the place to invent new terminology. I make this appeal here on the assumption that one or two editors might be influential cardiologists who can do something.

  Solo Owl   15:15, 24 September 2012 (UTC) — Preceding unsigned comment added by Eall Ân Ûle (talk • contribs)


 * Those geezers are lucky, but their heart is failing to some extent. This can be kept in check with medication and lifestyle advice. I agree that the term is clumsy (it is commonly confused with "cardiac arrest", which is absolute 100% failure of the heart), but it is the one that it widely used and accepted. JFW &#124; T@lk  18:39, 24 September 2012 (UTC)

low salt diet
The low salt diet article cites a couple primary sources to claim low salt diet might increase death risk for systolic heart failure patients. (Obviously that's true for anyone on a "no salt" diet, but low salt diet must be taken to mean something reasonable.)What concerns me is these primary sources are so recent (2013) and it's apparently not textbook dogma yet.76.218.104.120 (talk) 21:54, 12 March 2013 (UTC)

wrong citation
Article says: "Common causes of heart failure include myocardial infarction and other forms of ischemic heart disease, hypertension, valvular heart disease, and cardiomyopathy.[4]" However, I read the original paper. It does not categorize heart failure in this way. — Preceding unsigned comment added by 24.107.12.132 (talk) 01:21, 7 September 2013 (UTC)

New guideline
10.1016/j.jacc.2013.05.019 - ACC/AHA 2013. JFW &#124; T@lk  16:38, 6 October 2013 (UTC)

Sex
This paragraph is misplaced and requires editing, "==Prognosis==Heart failure is associated with significantly reduced physical and mental health, resulting in a markedly decreased quality of life.[52][53] With the exception of heart failure caused by reversible conditions, the condition usually worsens with time. Although some people survive many years, progressive disease is associated with an overall annual mortality rate of 10%.[54]" Autodidact1 (talk) 10:49, 25 November 2013 (UTC)

Defining HFpEF, HFREF & ejection fraction
It would be great if the intro (and the relevant sections lower down) explained the new terminology for systolic dysfunction/failure and diastolic dysfunction/failure. The introduction section of the NICE guidelines on HF are a good source for the technical descriptions I think, and so is this Cochrane review. Although the AHA's description doesn't get the "What it is" bit exactly right (sounds more like volume), other bits are really well-explained. (Good to clarify whether type of failure is different for the ventricles.)

The Heart Failure Society has some really great easy-to-understand language to explain all this, and so does the Mayo Clinic. (In terms of the numbers about what fractions are normal etc, NCI Thesaurus also has that.)

(Forgot to sign this sorry, plus added a question about ventricles) Hildabast (talk) 19:26, 23 May 2014 (UTC)

Synonymous
I had a huge issue finding any source that was not copied and pasted from Wikipedia that claimed that many people beleive heart failure is the same as MI or cardiac arrest. And we also already mention it in the lead so do not feel it needs a hatnote  Doc James  (talk · contribs · email) (if I write on your page reply on mine) 23:26, 6 June 2014 (UTC)
 * I'm not going to argue about your lack of sources online, but I felt it reasonable to assume that average laypeople, who may well not know the distinction between a 'heart attack' and 'failure', would benefit from a quick courtesy disambiguation, rather then reading through the end of the second paragraph to find out they are not the same. A heart attack, colloquially, can be thought of as a failure. Similar logic applies to users who may wikilink to heart failure when what they mean is heart attack or vice versa (e.g. when trying to avoid closely paraphrasing a source). Precedence exists in that Cardiac arrest and Heart attack have courtesy hatnotes. Reasonable assumptions about human behavior need not follow WP:MEDRS. --Animalparty-- (talk) 23:57, 6 June 2014 (UTC)
 * Heart attack is often used to mean both MI and cardiac arrest. And there are good sources to back this up. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 00:12, 7 June 2014 (UTC)

Author link
Someone placed a bizarre floating link at the top of the article that runs under the header text. I've removed it, but I'm placing it here for posterity:

- Authors

~ Michael Chidester (Contact) 21:47, 12 August 2014 (UTC)


 * This bizarre floating link adds "authors". It is an example of something I have proposed to WP:MED. Feel free to join the discussion. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 01:28, 14 August 2014 (UTC)

I also have to strongly question what the coding is doing there. It was originally placed there as basically a sandbox edit while a proposal was taking place (which I thought was a little off to begin with). If it's now being retained because WP:MED approved it, I don't think that's a strong enough reason. This is a change to the interface, essentially, and a WikiProject has no authority to present a slightly modified interface on select articles. A change like this requires community consensus, and the community was less than enthusiastic when the idea was presented to them. It really needs to be removed. --Bongwarrior (talk) 04:05, 24 December 2014 (UTC)
 * The community was opposed with having it across all of Wikipedia by default. This discussion supports it on medical articles  Doc James  (talk · contribs · email) 04:33, 24 December 2014 (UTC)
 * That's great, but they have zero authority to enact such a change, even if it's restricted to medical articles. The interface needs to remain consistent site-wide. Exactly how many other articles have this byline? --Bongwarrior (talk) 04:48, 24 December 2014 (UTC)
 * How many articles? Only this one. Doc James  (talk · contribs · email) 06:08, 24 December 2014 (UTC)
 * What a relief. Have I adequately explained why I think it's a pretty bad idea, and can we go ahead and remove the link at this point in time? Or do you think some outside opinions would be beneficial? --Bongwarrior (talk) 18:06, 24 December 2014 (UTC)
 * Have asked others at WPMED to comment. Having one example of this as we work on improving it is not an issue. It has been here for months. Doc James  (talk · contribs · email) 09:12, 25 December 2014 (UTC)
 * As a practical matter, regardless of the long-term merits of including this, it appears not to work currently - probably because it depends on a tool on the WMF servers, and they seem to only be working intermittently. AndyTheGrump (talk) 09:24, 25 December 2014 (UTC)
 * Good to know it does not work on Firefox. It used to. Doc James  (talk · contribs · email) 10:27, 25 December 2014 (UTC)
 * Yes, the server is not responsive. And it overlaps with the word "encylopedia" using Firefox, obscuring both words. It looks ok using Chrome, but I haven't checked it using Explorer because I don't have Explorer installed on my PC. I suggest removing it. WPMED cannot act this independently; it requires full community consensus. Are we trying to become Citizendium? Graham Beards (talk) 09:50, 25 December 2014 (UTC)
 * Yes the server appears to not be working again. It was a day or so ago. Agree issues with reliability. Doc James (talk · contribs · email) 10:28, 25 December 2014 (UTC)


 * To be honest, I think it should be removed. It was a good idea, but it can only work Wiki-wide after widespread consultation. It is sad that no consensus emerged about this, because I agree that we could all do with getting a bit of credit for our work. In my vision there is a button next to "View history" that says "Contributors", and shows the names of the key contributors. JFW &#124; T@lk  19:48, 25 December 2014 (UTC)

Yeah, this is definitely bizarre. Even if the underlying idea were sound and could be implemented on a local consensus (I really don't think that's appropriate), this particular implementation is poorly done, confusing and apparently inconsistent across browsers. Absolutely remove it. 0x0077BE ( talk ·  contrib ) 05:14, 26 December 2014 (UTC)
 * Yes needs more development agree. Doc James  (talk · contribs · email) 12:06, 26 December 2014 (UTC)

Hello. This project is described at WP:Wikicredit under the "Byline changes" heading. , I disagree that this needs to be discussed site-wide when it is implemented in such a narrow scope. said that it was just used on this article; I thought there was consensus to try this on a few hundred articles. Wikipedia is a place which is friendly to experimentation and I think trials should happen in small controlled spaces. There can be debate about the size, range, and duration of experiments, but I hope that experiments are not excessively prohibitive to run. Michael, considering past community support for this, under what circumstances could you also be supportive for trialing this feature?  Blue Rasberry  (talk)  17:05, 27 December 2014 (UTC)
 * No need to invoke me, I have no horse in this race. I only addressed it because I was doing code cleanup to a variety of disease pages and noticed the anomaly, concluding that it was somebody messing around with the interface and negatively impacting the page appearance. Disputes between WP:MED and the broader community are not relevant to my interests. ~ Michael Chidester (Contact) 21:25, 27 December 2014 (UTC)
 * This change is being discussed here. Ca2james (talk) 16:57, 7 January 2015 (UTC)

Proposed merge with Coronary insufficiency
Coronary insufficiency is a definition of Heart failure and really no justification for its own page Iztwoz (talk) 05:58, 13 July 2015 (UTC)
 * That is incorrect. Insufficiency of the coronary arteries is not synonymous with heart failure. The stub was of desperately poor quality and I have simply redirected it to coronary artery disease. No merge needed. JFW &#124; T@lk  14:35, 13 July 2015 (UTC)
 * Agree with JFW Doc James  (talk · contribs · email) 20:19, 13 July 2015 (UTC)
 * Already thanked JFW for redirect to CAD. Does something need clarifying - the first sentence of Heart failure says that "it occurs when the heart is unable to pump sufficiently to maintain blood flow to meet the body's needs".[1][2][3] which I interpreted as what coronary insufficiency stated ? --Iztwoz (talk) 21:12, 13 July 2015 (UTC) Also article stated that causes were mainly inflammation and no mention was made of stenosis etc. --Iztwoz (talk) 21:19, 13 July 2015 (UTC)
 * Coronary insufficiency is when not enough blood goes to the heart. Heart failure is when the heart does not pump enough blood for the body. Doc James  (talk · contribs · email) 21:22, 13 July 2015 (UTC)

Expansion!
This article could do with a WP:MCOTW nomination. It needs image support, more on radiology, myocardial myodynamics, underlying causes and mechanisms, the significance of a renal impairment in CCF etc etc. JFW | T@lk  10:58, 20 October 2005 (UTC)

Expansion
Maybe there could be more information on heart failure, like the difference between each type of heart failure (left, right, congestive), the symptoms involved, specific treatment given. Could be made so that profesionals can use the information to.


 * Yes, there could indeed. Would you like to help? JFW | T@lk  22:17, 30 November 2005 (UTC)+

Dyspnea
Im a nursing student and I have found that in this article it is mentioned CHF causes SOB, however it doesnt outline the cause of the SOB in reation to CHF. ie: The pathophysiology behind the dyspnea


 * Pulmonary congestion and pulmonary edema. JFW | T@lk  10:41, 23 April 2006 (UTC)

How do most of you rate the readability of the article?
I've just read through the article, hope fully to gain more of an insite into my Mum's condition. I'm sure the article is accurate to the nth degree - unfortunatly it may as well be written in a foreign language!

I'm told that the mark of a great author is someone who can take a complex, highly technical subject and present it in a way that's easy to understand to non-technical folks. I for one would be eternally grateful if someone with such an ability could attempt this with this article.

222.154.235.62 08:05, 4 August 2006 (UTC)


 * No need to be so forceful. Just state which terms are particularly unclear, and we can work something out. Experts often presume that their audience understand some of their jargon, which may explain the article's poor readability. JFW | T@lk  10:37, 21 August 2006 (UTC)

A hard topic to write about
This article has a lot of potential. Unfortunately, CHF is not only a big topic, but an extremely complex one. There are fellowships that focus on just heart failure and transplant cardiology.:-(

Anyway, just adding a reference that should be in the article. It basically says that women are more likely to have diastolic dysfunction and more comorbid conditions while men are more likely to have systolic dysfunction. Some day I may take a stab at a rewrite of the article...

Mendes LA, Davidoff R, Cupples LA, Ryan TJ, Jacobs AK. Congestive heart failure in patients with coronary artery disease: the gender paradox. Am Heart J. 1997 Aug;134(2 Pt 1):207-12.

Ksheka 15:30, 4 November 2006 (UTC)

ICD's
Systematic review on ICD's, probably quite relevant here and a hot topic: http://www.annals.org/cgi/content/abstract/147/4/251 JFW | T@lk  23:49, 20 August 2007 (UTC)

Cardiac Arrest
I just want to check something. In the article introduction, it is mentioned that heart failure is "not to be confused with...cardiac arrest, which is the cessation of normal cardiac function in the face of heart disease." However, is cardiac arrest only associated with heart disease? I was under the impression that cardiac arrest merely referred to cessation of heartbeat. Checking out cardiac arrest, I got "A cardiac arrest, or circulatory arrest, is the abrupt stop of normal circulation of the blood due to failure of the heart to contract effectively during systole." The article also mentions hypoxia and hypothermia as possible causes of cardiac arrest, neither of which are disease related. Could someone please clarify this?
 * Good call. I changed this in the top of the article. Ksheka 13:25, 28 November 2006 (UTC)

I would argue that [cardiac arrest] is probably an outdated term. What actually stops is meaningful propagation of the sinoatrial/atrioventricular tree and subsequent sympathetic outflow engaging biomolecular systole. Sinoatrial propagation as interpreted by the traditional electrocardiogram (EKG)affords an easily reproduced electrical signature of the living myocardium, heavily biased to systole. Silencing the sympathetic/forward/electrical perfusion of the heart implies a great diversity of differential etiologies and diagnoses. Once the electrical supply has been catastrophically compromised, biomolecular failure soon follows. In cardiac arrest, a new EKG is seen when the sinoatrial tree fails and gives an electrical signature of parasympathetic/backward/electrical control. Evidence of secondary electrical/parasympathetic control of the myocardium is seen as [agonal rhythm] and [ventricular fibrillation]. Once full arrest/cessation of electrical systole and and electrical diastole have occured, a flat line is observed on the EKG. --Lbeben (talk) 23:53, 27 November 2007 (UTC)
 * Sorry this reads as Original research.
 * "biomolecular systole", no hits on Google and, far more importantly, none at PubMed
 * What evidence is there that ventricular fibrillation is due to parasympathetic control? Surely a transplanted heart, which does not have any parasympathetic vagus innervation, may undergo VF ? David Ruben Talk 00:26, 28 November 2007 (UTC)

Glucose
High glucose in nondiabetic patients admitted with heart failure is predictive of poor outcome. JFW | T@lk  10:37, 21 August 2006 (UTC) Duration of poor glycemic control in diabetes is proportional to ischemic burden in heart failure.--Lbeben (talk) 00:31, 28 November 2007 (UTC)

Pathophysiology
has been writing the pathophysiology section, with making some important improvements. But when I read the new section, all that strikes me is that it essentially rehashes the list of causes already mentioned before (HF due to ischaemia, infiltration, cardiomyopathy etc). I'd much rather see a section that actually describes processes like cardiomyocyte metabolism in heart failure, ventricular remodeling etc etc. Apart from the Neubauer source, do we have other useful sources that could be used as a scaffold for this section? JFW | T@lk  08:31, 21 November 2007 (UTC)

Fully agree that optimal biomolecular performance of the myocardium is an important determinant of heart failure. Biomolecular determinants are probably proportional and secondary to (blood) ischemic burden. My peculiar concern is terminology in describing what heart failure actually means. Thankfully we are past terms such as [dropsy] in describing the pathophysiology in question. Specifying terms in an evolving text is a daunting but worthy endeavor, especially in the context of an online encylopedia. Best suggested starting point in this discourse is [Arthur Guyton, Textbook of Physiology].Lbeben (talk) 01:30, 22 November 2007 (UTC)

Proposal to delete Pathophysiology
Beg to differ, but lets start with "biomolecular performance of the myocardium", I promise you no cardiologist I have ever heard speak has used such tortuous language. I only can hazard a guess at "Biomolecular determinants are probably proportional and secondary to (blood) ischemic burden" (ponder on "biomolecular determinants", concept that proportional factors are not secondary to each other and finally can there be any non-blood ischemia) ? Finally Guyton as a medical textbook is not an appropriate starting point, as the level of description needs be comprehensible to high school students as well as to the average (non-medical) undergraduate – and Wikipedia is not a textbook.

This section does not differ from the list of causes already covered in the article, but instead seems an unstructured collection of points added in a manner that suggests WP:Synthesis of ideas (i.e. it is original research) and as such would be better deleted in its entirety. Whilst I have attempted previously to simplify the obtuse language used, the points remain unsupported by citation, e.g. "Heart failure can be can be considered as pathological degradation of Systole and Diastole.[citation needed]" not least that this is self-referential, warrants the clarity of the copyeditor's cutting of the Gordian Knot that its obfuscation deserves.

Therefore should we delete this section ? David Ruben Talk 00:38, 29 November 2007 (UTC)


 * I agree that in its present form, the section adds absolutely nothing to the article. It simply rehashes points already made elsewhere (e.g. valvular disease causing heart failure), and otherwise completely fails to systematically present the mechanism by which the heart fails. No word about ventricular remodeling, no word about what systolic and diastolic heart failure actually means and what the differences are... We need a much clearer approach, and I think deletion of the section is indeed warranted. JFW | T@lk  03:28, 29 November 2007 (UTC)


 * I agree as well. The present compilation lacks coherence and meaning. If we wipe the slate clean, how can a more lucid approach to an article about pathophysiology in heart failure be attempted? In my view a very flexible outline is required in elaborating the causes of heart failure and their relationships to one another. Understanding of degradation of systole and diastole lends itself to an attempt/articles of definition of systolic heart failure and diastolic heart failure.
 * In my opinion, mathematics that illuminate systole and diastole would be an excellent starting point readily appreciated within and outside the medical community. Inclusion of the medical physics community in this debate is suggested.
 * Cardiac output and ejection fraction are perhaps the best known and inexpensively imaged mathematical representations of systole. Simple inversion of these bedrock terms yields cardiac input and injection fraction, readily applied to diastole.
 * If a mathematical framework is agreed upon as a definitive construct of the outline of the article, other manifestations of failure can be added and edited as they are published. Examples would be pressure/volume relationships, blood mass and viable/nonviable myocardial mass, stress/strain/compliance, geometry/wall thickness and adaptive modeling, sympathetic and parasympathetic electrical perfusion of the myocardium, ATP/calcium, blood supply and ischemia, etc.
 * Our present grasp of pathophysiology in heart failure calls to mind the parable of a troupe of blind men examining an elephant and announcing what it is. A Wikipedia definition of the elephant demands cooperation and collaboration amongst many disciplines. If I can be of further service in preparing the proposed outline, please let me know.--Lbeben 03:12, 1 December 2007 (UTC)
 * Propose inclusion of work by [Torrent-Guasp] in the pathophysiolgy article. —Preceding unsigned comment added by Lbeben (talk • contribs) 06:14, 6 December 2007


 * I've completely overhauled this section! Agreed with you guys, the old one was a baffling mess and desperately needed a change, considering this is such a common and well-known disease. (By the way, I'm a 2nd year medical student and these are my own notes, so there could well be errors and it most likely isn't up to date with cutting-edge research. Its drawn from lecture notes and textbooks so I also haven't included any references, sorry. Feel free to make changes as needed :D ) Thebagman (talk) 00:03, 10 December 2007 (UTC)

Device Therapy in Heart Failure
Suggest inclusion of an article about devices that impart passive restraint of the myocardium as a means of addressing geometric degradation /pathophysiology in heart failure. Acorn Cardiovascular and Paracor Medical are the top two American companies in pursuit of this intellectual property. Their patents are open to the public on the US Patent and Trademark Office official web site and readily linked and quoted as references to the proposed article. --Lbeben (talk) 00:58, 12 December 2007 (UTC)


 * Take care with this, if they are "in pursuit of this" then this is under development &/or has not yet been used in clinical setting much, has yet to be evaluated by regulatory bodies, and therefore yet to be assessed by wider community of cardiologists. As such it therefore currently forms zero impact in the treatment of patients currently with heart failure and WP:UNDUE needs be considered, also are there yet independant reliable third-party sources to WP:Verify this as being WP:Notable or of significance (company's own claims or patent applications are generally not in themselves WP:RS). So probably too soon to make (any/much) mention of this yet :-) David Ruben Talk 02:23, 12 December 2007 (UTC)


 * Aye. Have you looked more into the mathematics behind what they are doing?--Lbeben (talk) 02:11, 13 December 2007 (UTC)

No, we should not be expected to "look into mathematics" to understand contributions to this article. If a treatment is experimental, I would not normally add it unless every single scientific review on the subject tauts it as "the next big thing". I'm not seeing that here. JFW | T@lk  08:09, 16 December 2007 (UTC)

Translation into Chinese Wikipedia
The 16:11, 15 December 2007 Thebagman version of this article is translated into Chinese Wikipedia.--Philopp (talk) 20:30, 16 December 2007 (UTC)

Moved from the article
added some content that needs sourcing and rephrasing before it can be readded:


 * Rate of hospitalization is approximately equal, however the prognosis for diastolic heart failure is better than systolic heart failure.
 * Annual mortality: Healthy people = 1%
 * Diastolic with CAD = 5% - 7%
 * Diastolic without CAD = 2% - 3%
 * Systolic = 10% - 15%
 * Complication rate is about the same regardless of type of heart failure


 * This is hard data without a source.


 * Diastolic and systolic failure have some variance also. Systolic failure has the following charateristics:
 * HF with reduced ejection fraction
 * Reduction in muscle mass
 * ↓ contractility
 * dilated chamber
 * ↑ cardiac volumes
 * ↓ Left ventricular ejection fraction (LVEF < 40%)


 * Diastolic heart failure presents the following:


 * HF with preserved ejection fraction
 * Restriction of ventricular filling
 * Ventricular stiffness and hypertrophy
 * Impaired filling due to abnormal relaxation
 * Normal sized chamber, normal emptying, (LVEF > 40%)
 * Does not fall within the guidelines for ACE-1 or ARB
 * Less research has been done on this type of heart failure


 * Diastolic heart failure can often times lead to eventual systolic failure. Most research to date has been done on systolic heart failure treatment, therefore most treatment recommendations are directed toward systolic failure.


 * This is useful content (we previously did not distinguish between systolic and diastolic heart failure), but it addresses more the pathophysiological differences and hence should not be in the "signs and symptoms" section. Also, the bullet point presentation reads more like a medical student's lecture notes. JFW | T@lk  07:44, 3 January 2008 (UTC)

Chronic venous congestion
Would somebody take a look at Chronic venous congestion and Heart failure cells and deduce whether or not they merit their own articles, and/or should be referenced in this one? BigBlueFish (talk) 23:52, 6 May 2008 (UTC)

Prevention?
Since heart failure is a common early killer, it would be nice if a section on prevention could be included. Even though the article gives details of how HF should be treated (reduce weight, low salt etc) which gives some clues about prevention, it would be better if there was a specific section on prevention, even if there was little to say about it. (My guess is that high alcohol consumption may be one of the causes). 80.2.206.140 (talk) 11:23, 10 June 2008 (UTC)


 * A large number of causes is listed. The only real way to prevent heart failure is treating these conditions - antihypertensives for high blood pressure, cutting down for alcoholics... In a sense, heart failure is prevented by ACE inhibitors after myocardial infarction. JFW | T@lk  11:55, 25 June 2008 (UTC)

CFS/ME
added that heart failure could be caused by chronic fatigue syndrome. The source, however, doesn't reflect this. Rather, it states that CFS/ME has the same impact on quality of life as heart failure. JFW | T@lk  11:58, 25 June 2008 (UTC)

PMI
The term PMI used in this article is a new one on me, and looking around on the internet (none of my books mention it), it seems to be the same as the apex beat - which is a more widespread term. I've therefore changed the wording in this article, created a page for PMI and re-directed it to apex beat.

Also, I've never heard of obesity causing heart failure by squashing the heart so I removed the phrase "In obesity cases, the heart is squashed by fat surrounding it, giving it too little room to beat" and changed the sentence to include coronary artery disease. The only common restricitive causes of CHF I can find are restricitive cardiomyopathies and pericardial disease, neither of which seem to be related to epicardial fat restricting beating. I found one case report of a woman with Pfeifer-Weber-Christian disease who did have some changes in the epicardial fat, but this wasn't the only pathology and I don't think it's really common enough to justify the statement. There is also adipositas cordis, but this is vanishingly rare and again doesn't warrant a generic sentence about all obese people.

If anyone thinks that this is wrong, please let me know. Cheers Iain Joncomelately 09:11, 5 July 2006 (UTC)

I agree entirely with you on the obesity issue. PMI stands for Point of Maximal Intensity, and is used (by me anyway) mainly when talking about auscultating the heart. In a normal heart then this is going to more or less correspond with the apex beat, but when murmurs are present it can be used to describe the point at which the murmur is heard loudest. Alsiola vet (talk) 05:18, 12 July 2008 (UTC)

Readmissions
Hard to predict: http://archinte.ama-assn.org/cgi/content/abstract/168/13/1371 JFW | T@lk  06:56, 15 July 2008 (UTC)

Hyponatremia
I'd like to expand on the Hyponatremia section - often overlooked - this accounts some 25.3% of patients admitted with heart failure have this condition on admission (OPTIMIZE-HF trial) - resulting in increased in-hospital and post-discharge mortality. There is a new paper which discusses treatment options, as there are no guidelines for treatment in heart failure settings. Melharmcc (talk) 14:03, 1 September 2008 (UTC)


 * With recent results on the vaptans this is definitely worth discussing in a few lines. Have you a recent reliable source for such a section? JFW | T@lk  22:50, 1 September 2008 (UTC)

Collaboration of the Week: Readability, and other meanderings.
Heart Failure seems to be very poorly understood in the general patient population, and I think we have to be careful to make this an accessible / readable article, remembering that Wikipedia is not a textbook. The header and terminology section need to be particularly simple.

I'm planning to make some edits over the next couple of days, but make the following suggestions for Collaboration & discussion:
 * dividing signs and symptoms into left and right is not particularly physiological - ie. peripheral oedema (classically regarded as "right heart backward failure") is usually the result of poorly perfused carotid receptors triggering ADH, and poorly perfused kidneys triggering the renin angiotensin system (ie. left ventricular forward failure).
 * dividing causes into left and right makes very little sense for the same reason... I would favour pressure load vs. volume load, or even valves/myocardium/peripheral circulation.
 * Treatment needs to be primarily changed into managing Acute decompensation, and managing Chronic disease.
 * The difference between drugs which impact on mortality (Alpha blockers + nitrates, ACE inhibitors, Angiotensin blockers, certain Beta Blockers, Aldosterone antagonists) and those that don't (everything else I'm afraid) needs to be emphasised.
 * The section on cardiopulmonary exercise testing should probably be merged with the cardiac transplantation/surgery section, because the vast majority of patients with HF won't get a transplant OR a cardiopulmonary stress test.
 * Substantial overall simplification needs to occur to improve readability.TamePhysician (talk) 03:48, 6 September 2008 (UTC)


 * I totally agree that education is vital and that many patients seem unaware what heart failure is, why they've got it, what their treatments are meant to achieve, and that it's a progressive condition. Could I suggest that you implement the changes you have recommended? JFW | T@lk  06:19, 7 September 2008 (UTC)


 * Thanks JFW, I'm underway with it, but plenty more to do.TamePhysician (talk) 11:37, 7 September 2008 (UTC)


 * In terms of readability, you might keep in mind the following:


 * I heard one of the prize winners, Professor Jacob, forewarn an audience of specialists more or less as follows: «In describing genetic mechanisms, there is a choice between being inexact and incomprehensible». In making this presentation, I shall try to be as inexact as conscience permits.


 * My own experience is that, in talking to patients, I am always surprised at how much difficulty they have with technical terms that are quite familiar to me. For that reason, I always use non-technical terms as much as possible, although I also include the technical terms so readers will get to learn them. Nbauman (talk) 22:25, 7 September 2008 (UTC)

Nitro
No mention was made of nitroglycerin in the management of CHF.

Will work on the acute treatment section. Have found an excellent guideline.

http://www.guideline.gov/summary/summary.aspx?doc_id=9328

Doc James (talk) 17:19, 17 September 2008 (UTC)


 * Yes, that and CPAP. JFW | T@lk  19:42, 17 September 2008 (UTC)

Observation
Observation: I have CHF and never had the "lighting bolt to the chest" pain, or really any other indication at all that there was anything seriously wrong with me. I went to a minor emergency clinic to see about my feet/legs swelling up, mainly because family members said "you look bad, see your doctor" and kept pestering me about it. After four hours in the clinic, they hooked me up to EKG - five minutes after that, I was in an ambulance on the way to the emergency room. Had I been aware of what a serious symptom swelling legs was, I would have gone three days earlier. Sorry if this doesn't belong here! —Preceding unsigned comment added by 66.142.93.50 (talk) 17:33, 23 December 2008 (UTC)


 * Leg swelling alone can have numerous causes. You didn't tell us what the EKG showed. JFW | T@lk  20:55, 23 December 2008 (UTC)


 * Sorry, I don't really know what the EKG showed. I saw it, and noticed that the up ticks looked kind of "mushy" and the down ticks were weak and very long but not present after every uptick. I'll ask next time I see the Doc. I guess my point is just that - swelling legs didn't seem all that important. Thinking back, I was a little bit out of breath, but not gasping for air or anything.

Heart failure guidelines
Someone created Image:Chronic Heart Failure.jpg and added it to the article. I reverted this change because I think images like this, containing mainly text, are difficult to edit by others and add little to the article. Furthermore, I'm concerned that part of the image contains copyrighted materials. Please comment. --Steven Fruitsmaak (Reply) 18:39, 4 February 2009 (UTC)

Xray of CHF
We need an X-ray of CHF. Currently the one we have is poor. Will try to get one if no one else has one easily available. Doc James (talk · contribs · email) 20:35, 2 November 2009 (UTC)

Pulmonary failure = heart failure
Can I get an explanation here please... I am confused, since doesn't "pulmonary failure" literally mean "lung failure"? Why then redirect or is this specific term used for something else. It is just confusing me, thanks. —Preceding unsigned comment added by Neikius (talk • contribs) 22:25, 11 April 2010 (UTC)


 * You were correct. I have redirected [pulmonary failure]] to respiratory failure, as they are for all intents and purposes identical. JFW | T@lk  21:32, 14 April 2010 (UTC)

poor writing in this article
"Acute decompensated heart failure is a term used to describe exacerbated or decompensated heart failure, referring to episodes in which a patient can be characterized as having a change in heart failure signs and symptoms resulting in a need for urgent therapy or hospitalization" This sentence is a very wordy way of saying pretty much nothing (lots of words and little content). This is just one example from the article... Much of this article may need a rewrite... --159.178.247.147 (talk) 12:38, 5 November 2010 (UTC)


 * sofixit JFW | T@lk  00:21, 8 November 2010 (UTC)

Prevalence
The following sentence makes no sense: "In developed countries, around 2% of adults suffer from heart failure, but in those over the age of 65, this increases to 6–10%." Is this per year, per decade, per lifetime, or what? 209.6.251.20 (talk) 11:49, 16 February 2011 (UTC)


 * It makes perfect sense, but it would help to add the word "prevalence". This means that at any point, 2% of the entire population have symptoms of heart failure. The lifetime risk will be roughly similar. Given that it is a chronic condition, the incidence will be much lower. JFW &#124; T@lk  20:32, 16 February 2011 (UTC)

What is meant by "congestive"
What exactly is meant by the word "Congestive" ... does that mean congested like my noes gets when I have a cold? Whats it congested with? -- (unsigned)


 * "Congestive" in this case means "distended with fluid". Your question implies that you think it's the heart that congested, but it's named because the heart is unable to pump efficiently enough to prevent fluid accumulation in other places, like the lungs or liver or peripheral tissue. So the "congestion" that gives the syndrome its name is found in the lungs or peripheral tissue, causing difficulty breathing or leg swelling. That being said, it's sort of an old-fashioned term, and the word "congestive" is mostly filler... one might just as well say "heart failure" in most instances. - Nunh-huh 06:26, 12 Feb 2005 (UTC)


 * I agree completely and wish to add that the misconception comes from the commonly used term congestive heart diseasewhich in context "congestive" means dilated. Congestive heart disease has its own list of syndromes altogether with most, commonly called congestive cardiomyopathy as a general medical condition.

--RichNelson (talk) 17:53, 28 May 2011 (UTC)

Right heart failure
I have a simple question about right-heart failure: what happens to the heart itself? The blood "backup" causes lower-extremity edema, ascites, jugular venous distension, etc. It would stand to reason that the right ventricle would hypertrophy. What about the left atrium? Will it also increase in size, due to the fluid overload?Dryphi (talk) 04:24, 8 August 2011 (UTC)