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Related Concept Videos

Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

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Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
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Heart Failure IV: Classification and Diagnostic Evaluation01:30

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Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
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Heart Failure VI: Adjunct Therapies01:22

Heart Failure VI: Adjunct Therapies

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Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
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Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

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The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
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Pathophysiology of Heart Failure01:17

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Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
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Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
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Association between locomotor muscle quality and cardiac function during exercise in heart failure with preserved ejection fraction.

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Tirzepatide Reduces LV Mass and Paracardiac Adipose Tissue in Obesity-Related Heart Failure: SUMMIT CMR Substudy.

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Related Experiment Video

Updated: Mar 18, 2026

A Surgical Model of Heart Failure with Preserved Ejection Fraction in Tibetan Minipigs
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Phenotype-Specific Treatment of Heart Failure With Preserved Ejection Fraction: A Multiorgan Roadmap.

Sanjiv J Shah1, Dalane W Kitzman1, Barry A Borlaug1

  • 1From Division of Cardiology, Department of Medicine, and the Feinberg Cardiovascular Research Institute, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, (B.A.B.); Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands (L.v.H., W.J.P.); Department of Cardiology, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands (L.v.H.); Department of Medicine, Medical University of South Carolina (MUSC) and the RHJ Department of Veterans Affairs Medical Center, Charleston (M.R.Z.); and Division of Cardiology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD (D.A.K.).

Circulation
|July 1, 2016
PubMed
Summary

Heart failure with preserved ejection fraction (HFpEF) treatment requires addressing comorbidities and diverse phenotypes. A personalized strategy targets HFpEF-specific signaling pathways for improved outcomes.

Keywords:
diastoleheart failureheart failure, diastolicphenotypetherapeuticsventricular function, left

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Area of Science:

  • Cardiology
  • Internal Medicine
  • Translational Research

Background:

  • Heart failure with preserved ejection fraction (HFpEF) is a growing clinical challenge, accounting for 50% of heart failure cases.
  • Unlike HF with reduced ejection fraction, HFpEF has shown resistance to traditional neurohumoral inhibition therapies.
  • Distinct systemic and myocardial signaling pathways, along with phenotypic diversity, contribute to HFpEF's complexity.

Purpose of the Study:

  • To propose a novel treatment strategy for HFpEF that accounts for its specific signaling mechanisms and phenotypic variations.
  • To elucidate the role of extracardiac comorbidities in driving cardiac remodeling and dysfunction in HFpEF.
  • To identify potential therapeutic targets within the identified signaling cascades.

Main Methods:

  • Review of current literature on HFpEF pathophysiology, focusing on systemic inflammation and endothelial dysfunction.
  • Analysis of signaling pathways linking comorbidities (metabolic risk, hypertension, renal insufficiency) to cardiac remodeling.
  • Exploration of targeted interventions for specific molecular and cellular processes in HFpEF.

Main Results:

  • Extracardiac comorbidities drive HFpEF through systemic inflammation and coronary microvascular endothelial dysfunction.
  • These mechanisms lead to left ventricular diastolic dysfunction, interstitial fibrosis, and cardiomyocyte stiffening.
  • Multiple therapeutic targets identified, including caloric restriction, statins, PDE5 inhibitors, exercise, diuretics, nitrate-nitrite, neprilysin/PDE9 inhibitors, and spironolactone.

Conclusions:

  • A personalized therapeutic approach is crucial for managing HFpEF due to its phenotypic diversity.
  • Targeting HFpEF-specific signaling cascades offers a promising avenue for treatment development.
  • A matrix approach, considering HFpEF presentations and predispositions, can guide personalized therapy selection.