Talk:Heart failure/Archive 2

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)

Exercise prevents heart failure
... in a dose-dependent manner. Because the heart is a muscle. 10.1161/CIRCULATIONAHA.115.015853 JFW &#124; T@lk  21:43, 10 November 2015 (UTC)
 * Incorporated into new prevention section (which requires expansion, but at least it's started now). Thanks for dropping this here, JFW! TylerDurden8823 (talk) 02:26, 4 December 2015 (UTC)


 * Anytime. I wish I had the opportunity to make full edits based on those sources, so thanks a lot for following it through! JFW &#124; T@lk  13:35, 4 December 2015 (UTC)

Misuse
From the article: "The term heart failure is frequently misused, especially when given as cause of death: it is not synonymous with "cessation of heartbeat"."

So, is the term "congestive heart failure" ever given as a cause of death? Shawnc 21:16, 23 October 2005 (UTC)


 * Well, it is, but the actual mechanism of death would still be ventricular fibrillation, pulseless electrical activity etc. Congestive heart failure itself is extremely unpleasant and carries a fairly strinky prognosis, but is not synonymous with cardiac arrest. JFW | T@lk  22:19, 23 October 2005 (UTC)


 * I want to add on by saying ultimately death (of course excluding brain death where the heart is still working) is due to cardiopulmonary arrest, regardless of the cause. But doctors cannot claim this on the death certificate (as it would basically be futile for statistical purposes, like when the WHO gathers data). Hence the "cause of death" can be many things. In fact on the death certificate doctors have to give a contributory cause also, like hypertension or diabetes, etc. So basically, congestive heart failure can be a cause of death, but in this article it would be misleading to say that it is the actual pathophysiological cause of death. User:Emortio | T@lk   —Preceding comment was added at 20:49, 30 May 2008 (UTC)


 * Actually because of the pulmonary edema, you'll die of hypoxic respiratory failure. At least in the state of California, you're required to list the proximal cause of death (v fib arrest, asystole, hypoxic-ischemic brain injury, hypoxic and/or hypercapnic respiratory failure, etc.) as well as the chain of events that lead to this cause (acute myocardial infarction, asphyxiation, congestive heart failure, exsanguination, etc. I think there are six lines on the death certificate from what I remember.) 22:53, 6 June 2008 (UTC) —Preceding unsigned comment added by 132.239.142.130 (talk)


 * talking of entering the "cause of death" on the death certificate, in my country Nigeria, what we do is to identify a primary and a secondary cause of death. The primary cause of death in most patients usually is cardiopulmonary arrest, except for brain dead patients with functioning heart and lung. However, the secondary cause of death is usually the event or disease state leading to the arrest, in this case heart failure.62.173.40.217 (talk) 06:33, 7 December 2015 (UTC)

Self-management
... is beneficial unless you're depressed, in which case it can be harmful 10.1161/CIRCULATIONAHA.115.018006 JFW &#124; T@lk  23:28, 22 March 2016 (UTC)

About dioxin & spironolactone and pimobendane
On the phrase In people with markedly reduced ejection fraction, the use of an aldosterone antagonist, in addition to beta blockers and ACE-I, can improve symptoms and reduce mortality it should be written aldosterone antagonist, such as spironolactone, Spironolactone is significant drug in heart failure and often is combined with a loop duretic such as Lasix (R)(furosemide). It does not lower potassium, contrary to frusemide. To my mind digoxin (initially extracted by a flower) is important as well for heart failure and although its effectiveness has been debated (it does lower morbidity but not mortality), we should not weigh on the side that it is not effective. Also, my brother's dog suffers (diagnosed after experiencing shortness of breath on walking and ascites - the last I guess is more common & prominent on dogs and other walking on 4 animals because of gravity) from heart failure (I guess after a viral disease from an enterovirus such as Echo or Coxsackie B- something not uncommon even on human) and among the rest drugs the vet prescribed a phospodiasterase inhibitor PDE3 (something like a brother of Viagra!)called Pimobendane. I don't know if there is human research on heart failure for this drug, but the veterinaries already use it! Of course, other drugs of this category (PDE3 inhibitors), inamrinone, milrinone and enoximone are used clinically for short-term treatment of cardiac failure, as wiki says. I was just wondering about pimobendane. 195.134.64.225 (talk) 07:52, 10 October 2016 (UTC)

In animals
Should we include information about congestive heart failure in animals (such as small dogs), and the treatment, etc.? -- siliconwafer 9/21/04

I mention below the drug pimobendane. Vets do not give digoxin to dogs as it is toxic. In fact it may be toxic for human as well, so blood level tests are recommended (as it may aggravate the results of hypokalemia (low potassium)). My brother's dog was administered Lasix (R) (furosemide, or in british English furosemide, a diuretic (water pill); it is called like this as it lasts 6 hours!), pimobendan (a PDE3 inhibitor) and an ACE inhibitor. I said him to ask the vet about taking a beta blocker (such as metoprolol) to slower the heart rate of the tired heart and also to remove ascites (water accumulated in the belly; prominent in dogs and 4 foot animals because of gravity) with a needle (paracentesis - large amounts should be avoided as it may cause rebound pulmonary edema). In the case of low albumin because of liver failure or kidney problems such as nephrotic syndrome or of malnutrition the doctor administers human albumin as an IV fluid, because low albumin is the cause of edema from low oncotic pressure (from low albumin, the main blood protein), contrary to high hydrostatic pressure on heart conditions such as heart failure where the heart as a pump is dysfunctional. ProBNP is a good lab test for helping in the diagnosis of decompensated heart failure (it can be ordered on the ER for differential diagnosis of dyspnoea (shortness of breath) in order to exclude heart failure 193.92.252.166 (talk) 15:57, 14 October 2016 (UTC)

NEJM review of HFPEF
10.1056/NEJMcp1511175 JFW &#124; T@lk  08:53, 10 November 2016 (UTC)

Ref to support
With respect to "as the result of a functional or anatomical abnormality of the heart." added to the first sentence.

We already say "These cause heart failure by changing either the structure or the functioning of the heart." a couple of sentences lower in the article. IMO no need to repeat it twice. Doc James (talk · contribs · email) 14:31, 1 March 2017 (UTC)

External links modified
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Lancet seminar
10.1016/S0140-6736(17)31071-1 JFW &#124; T@lk  13:58, 29 October 2017 (UTC)


 * NEJM About diuretics: 10.1056/NEJMra1703100 JFW &#124; T@lk  23:12, 15 November 2017 (UTC)

Primary sources versus reviews
Have removed the primary source and updated with this review. https://www.ncbi.nlm.nih.gov/pubmed/28460827 Doc James  (talk · contribs · email) 00:35, 28 November 2017 (UTC)

Text
The "of an unknown cause" is important as some of the earlier causes also result in cardiomyopathy.

This is unreferenced and wrong "elevated B-type natriuretic peptide (BNP) is a specific blood test indicative of heart failure."

This is less accurate " or a ventricular assist device (VAD). When some or all of these measures are insufficient, surgical intervention is considered: a heart transplant."

VADs are only used in cases at the same stage as heart transplants and thus fit better together. Doc James (talk · contribs · email) 19:43, 12 November 2018 (UTC)

Risk of Death: Ambiguous Phrase
Here's a curious sentence in the opening section: In the year after diagnosis the risk of death is about 35% after which it decreases to below 10% each year. Huh? What does this mean? Are we trying to say it decreases to below 10%? Or are we trying to say it decreases each year. Because they're not the same thing, and they kind of contradict each other. I think what it's trying to say is that it drops below 10% in the second year and stays that low. Or maybe it continues to drop.

When the line was first written, it said this: …after which it is below 10% each year. That's still clumsy, but a lot clearer. If that's the case, maybe a better way to word it is this: In the first year after diagnosis, the risk of death is about 35%, after which it drops below 10%.

Or maybe this: 'In the first year after diagnosis, the risk of death is about 35%. By the second year it drops below 10%.'

I don't want to make the change myself because I don't have access to the source. —MiguelMunoz (talk) 03:11, 11 April 2018 (UTC)
 * Sure adjusted Doc James  (talk · contribs · email) 19:47, 12 November 2018 (UTC)

Confusion over Stages
The article designates stages of heart failure with letters A, B, C, D; but at two points or more, references are made to stages using roman numerals.

From reports that my mother-in-law is suffering heart failure in stage I or II, I turned to Wikipedia for definition. Among Wikipedia's vast readership likely my reason for coming here is hardly unique to me and clarifying designations of stages of heart failure would benefit the readership. — Preceding unsigned comment added by 174.205.20.151 (talk) 18:13, 4 February 2019 (UTC)

Artificial heart
An anonymous editor added an artificial heart to the introduction in a sentence sourced to the 2010 version of the NICE guideline. This guideline does not mention artificial heart at all, so I have removed this pending better sources. At any rate, it should be discussed in the article body and not the introduction, because only a very small proportion of people with heart failure warrant VAD or transplant, let alone artificial heart.

Even NICE NG106 (2018), the updated version of the 2010 guideline, does not contain the words "artificial heart". This ESC guideline seems a good bet: 10.1002/ejhf.1236 JFW &#124; T@lk  09:00, 3 May 2019 (UTC)
 * Any artificial heart with low cardiac output will cause heart failure. Any heart transplantation in a baby will cause heart failure in the future, because baby's heart does not grow properly in the course of time. --Dr. Hartwig Raeder (talk) 19:34, 17 August 2019 (UTC)

Supplements
Certain complementary and alternative medicine supplements also carry a risk of exacerbating existing heart failure, and are not recommended.[28] IiKkEe (talk) 14:29, 1 September 2019 (UTC)
 * Aconite can cause abnormally slow heart rates and abnormal heart rhythms such as ventricular tachycardia.[28]
 * Ginseng can cause abnormally low or high blood pressure, and may interfere with the effects of diuretic medications.[28]
 * Gossypol can increase the effects of diuretics, leading to toxicity.[28]
 * Gynura can cause low blood pressure.[28]
 * Licorice supplement consumption can worsen heart failure by increasing blood pressure and promoting fluid retention.[28]
 * Lily of the valley can cause abnormally slow heart rates with mechanisms similar to those of digoxin.[28]
 * Tetrandrine can lead to low blood pressure through inhibition of L-type calcium channels.[28]
 * Yohimbine can exacerbate heart failure by increasing blood pressure through alpha-2 adrenergic receptor antagonism.[28]

Bullet format or prose for subsection on supplements?
Doc James prefers prose, I prefer bullets. Perhaps others will weigh in here. Obviously there is no right or wrong. IMO the bullet format is more readable.


 * I think prose looks more fitting for an encyclopedia. That's my two cents. TylerDurden8823 (talk) 04:38, 7 September 2019 (UTC)


 * A small table can be helpful, particularly when linking a name with a result/reaction. Otherwise I too would prefer prose for this content. JFW &#124; T@lk  21:50, 8 September 2019 (UTC)

Restructuring "Signs and Symptoms"?

 * I am wondering if "Signs and Symptoms" could be restructured and simplified instead of maintaining the distinction between right and left sided symptoms. As it mentions, this is a somewhat arbitrary distinction and the way it is written now is confusing to a lay audience. The current structure also prevents addition of systemic symptoms such as muscle wasting and weakness. Maybe just separate out physical exam findings and symptoms as subheadings? I would be happy to work on this, wanted to post here for discussion first. Pattkait (talk) 15:48, 12 November 2019 (UTC)

Updating References
The 4th reference in this page (National Clinical Guideline Centre (UK), August 2010) is out of date. I recommend updating this reference as well as relevant information to newer version of the same publication "Chronic Heart Failure in Adults" published in 2018. Bruce Chen 0010334 (talk) 06:51, 19 November 2019 (UTC)

New section on History
Having added a new section on history I've been working on in my sandbox, complete with references, I'm looking forward to anyone's comments and improvements. NikosGouliaros (talk) 18:54, 27 February 2021 (UTC)

Heart Failure definition
(I am tempted to boldly change it, but being an inexperienced Wikipedia editor it is probably a good idea to get some second thoughts:)

Enormous concepts like heart failure are often difficult to define; have multiple acceptable definitions; and different definitions are appropriate for different contexts and audiences. The current definition, however, Heart failure is when the heart is unable to pump sufficiently to maintain blood flow to meet the body tissue's needs for metabolism, though not unsourced, may be considered inadequate. A big number of patients with heart failure (probably the majority) have their organs' metabolism adequately supported by the amount of blood pumped into them; their symptoms are caused by blood congestion upstream of the heart; in other words, by blood being insufficiently pumped and therefore accumulated in the veins. Pulmonary edema, one of the most dramatic manifestations of heart failure, is caused by such blood congestion in the lungs' vascular bed. To use some of the article's terms: the current definition covers only the forward function of the heart; the backward function failure, though explained in the article, is not covered by this definition.

My proposal is, first, to disengage the definition from the tissues' needs for metabolism, which as a matter of fact are not mentioned as such at those sources cited that I have access to. Moreover, it is important to actually name it a syndrome, which is defined in the respective article as distinct from a disease (and as a word is nowhere mentioned in the current article), according to publications by three major medical authorities on heart failure. The broadest correct definition could be: Heart failure is a syndrome of symptoms and signs caused by impairment of the heart’s action as a pump supporting the blood flow through the body. Possible augmentation: resulting from a structural and/or functional cardiac abnormality. Second possible augmentation, more technical, but necessary from a pathofysiologic point of view: that disrupts hearts filling with blood or ejecting it:

Heart failure (HF), also known as congestive heart failure (CHF) and (congestive) cardiac failure (CCF), is a syndrome of signs and symptoms caused by impairment of the heart's action as a pump supporting the blood flow through the body; it can result from a structural and/or functional abnormality of the heart that disrupts heart's filling with blood and ejecting it.

Or, to ease the reader more gradually into the topic: Heart failure (HF), also known as congestive heart failure (CHF) and (congestive) cardiac failure (CCF), is a set of manifestations caused by impairment of the heart's action as a pump supporting the blood flow through the body; its signs and symptoms can result from a structural and/or functional abnormality of the heart, that disrupts its filling with blood and its ejecting it during each heart beat.

Details of the actual phrasing are obviously open to improving. (I also weakly propose erasing decompensatio cordis, just because it's the first time I've encountered it and I don't know a context that it could be expected to be used). NikosGouliaros (talk) 21:57, 3 March 2021 (UTC)
 * Decompensatio cordis returns only one article in English in PubMed, and a Google search shows it's mostly used in Dutch. I strongly propose removing it (and I'm already removing the initialism DC, it seems to be unsupported in English. NikosGouliaros (talk) 20:17, 4 March 2021 (UTC)

Abandoned user draft
User:NikosGouliaros made some changes here up to 25 March 2021 which seem to have been accepted. After that he carried on working on further edits at User:NikosGouliaros/sandbox Heart Failure, which have apparently not yet been incorporated into the live article. Please would an interested editor assess what is useful, incorporate it, blank the WP:COPYARTICLE, and leave a note here when done? – Fayenatic  L ondon 19:15, 8 August 2021 (UTC)
 * done, the classification section might be a bit small but it doesnt really work without being at the top and pretty much everything in the sandbox classification was already in signs and symptoms and seemed more like notes than text actually supposed to be used --Amphibian32 (talk) 14:58, 9 August 2021 (UTC)

Research directions
This section doesn't make much sense. If the evidence is worth mentioning, why call it low quality? TheIsle (talk) 19:21, 25 August 2022 (UTC)

Ejection fraction
This article has 31 occurrences of the phrase "ejection fraction", but no obvious definition. Since the phrase is so important to the article, such a definition should be added. It might be useful to have two definitions: one in the lead that is brief and non-technical, and a more detailed definition in its own section. In addition, the first occurrence should be replaced by the wikilink Ejection fraction. I'm not in medicine, so I would rather another WP editor take on this task. David Spector (talk) 15:07, 12 August 2023 (UTC)