Heart failure is a syndrome of ventricular dysfunction. Left ventricular failure causes shortness of breath and fatigue, and right ventricular failure causes peripheral and abdominal fluid accumulation; the ventricles can be involved together or separately. Diagnosis is initially clinical, supported by chest x-ray, echocardiography, and levels of plasma natriuretic peptides. Manifestations differ depending on the extent to which the LV and RV are initially affected. Clinical severity varies significantly and is usually classified according to the New York Heart Association system ( I class – IV class ). Treatment includes diuretics, ACE inhibitors, angiotensin II receptor blockers, β-blockers, aldosterone antagonists, digitalis, specialized implantable pacemakers, and correction of the underlying disorder. Causes of Heart failure are Cardiac and Systemic disorders.

Cardiac:

• Myocardial damage (MI, Myocarditis, Cardiomyophathy, Chemotherapy drugs),
• Valvular disorders (Aortic stenosis, Mitral regurgitation),
• Arrhythmias (Bradyarrhythmias, Tachyarrhythmias),
• Conduction defects (AV node block, Left bundle branch block),
• Reduced substrate availability (eg, of free fatty acids or glucose – Ischemia),
• Infiltrative or matrix disorders (Amyloidosis, Chronic fibrosis, Hemochromatosis)

Systemic:

• Disorders that increase demand for CO (Hyperthyroidism, Paget's disease)
• Disorders that increase resistance to output (afterload) (Aortic stenosis, Hypertension)

Patients with HF have a poor prognosis unless the cause is correctable. Mortality rate at 1yr from first hospitalization for HF is about 30%. In chronic HF, mortality depends on severity of symptoms and ventricular dysfunction and can range from 10 to 40%/yr. Heart failure (HF) affects about 5 million people in the US; > 500,000 new cases occur each year.