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Related Concept Videos

Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

633
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
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Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

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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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Heart Failure I: Introduction01:27

Heart Failure I: Introduction

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Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
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Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

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Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
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Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

184
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 III: Clinical Manifestations01:26

Heart Failure III: Clinical Manifestations

410
Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...
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Related Experiment Video

Updated: Jan 3, 2026

Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
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Microvascular Dysfunction in Heart Failure With Preserved Ejection Fraction.

Domenico D'Amario1, Stefano Migliaro1, Josip A Borovac2

  • 1Department of Cardiovascular Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.

Frontiers in Physiology
|November 22, 2019
PubMed
Summary

Heart failure with preserved ejection fraction (HFpEF) is linked to microvascular dysfunction. Research explores this connection, aiming to identify new treatments targeting endothelial impairment for better patient outcomes.

Keywords:
diastolic abnormalitiyheart failuremicrovascular dysfunctionprecision medicinepreserved ejection fraction

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Area of Science:

  • Cardiology
  • Pathophysiology
  • Pharmacology

Background:

  • Heart failure with preserved ejection fraction (HFpEF) constitutes 50% of heart failure diagnoses and differs significantly from heart failure with reduced ejection fraction (HFrEF) in etiology and progression.
  • Comorbidities like metabolic syndrome and hypertension can induce systemic inflammation, affecting endothelial function and leading to myocardial fibrosis and stiffening.
  • Microvascular dysfunction is increasingly recognized as a key factor in HFpEF pathogenesis, potentially driven by inflammation and hypoxia.

Purpose of the Study:

  • To review the evidence supporting a microvasculature-driven etiology of HFpEF.
  • To discuss the clinical correlations, diagnostic approaches, and therapeutic strategies for microvascular dysfunction in HFpEF.

Main Methods:

  • Review of current scientific literature and evidence.
  • Analysis of pathological pathways linking comorbidities to myocardial dysfunction.
  • Exploration of potential pharmacological targets and treatment strategies.

Main Results:

  • Growing evidence implicates microvascular dysfunction as a primary driver of HFpEF.
  • Comorbidities contribute to systemic inflammation, impacting the endothelium and leading to cardiac fibrosis.
  • Several molecular pathways and potential therapeutic targets, including the nitric oxide (NO) pathway and TGF-β, are being investigated.

Conclusions:

  • Microvascular dysfunction is a critical element in the pathophysiology of HFpEF.
  • Further research is needed to translate findings into effective clinical treatments for HFpEF.
  • Targeting endothelial impairment offers a promising avenue for novel HFpEF therapies.