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European Journal of Heart Failure 2008 10(2):170-175; doi:10.1016/j.ejheart.2007.12.007
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© 2008 European Society of Cardiology

Acute heart failure as "acute endothelitis" — Interaction of fluid overload and endothelial dysfunction

Paolo C. Colomboa,*, Duygu Onata and Hani N. Sabbahb

a Department of Medicine, Division of Cardiology, Columbia University New York, New York, USA
b Department of Medicine, Division of Cardiovascular Medicine, Henry Ford Health System Detroit, Michigan, USA

* Corresponding author. Division of Cardiology, New York-Presbyterian Hospital, 622W 168th Street, PH 12-134, New York, NY 10032, USA. E-mail address: pcc2001@columbia.edu (P.C. Colombo).

Key Words: Heart failure • Endothelial • Inflammation

Received October 15, 2007; Accepted December 12, 2007

The first 150 words of the full text of this article appear below.


   1. Introduction
 
Acute heart failure (AHF) is defined as a change in heart failure (HF) symptoms (i.e. dyspnoea, abdominal bloating, and fatigue) and signs (i.e. pulmonary crackles, jugular vein distension, and peripheral oedema) resulting in a need for urgent therapy. Symptoms and signs of HF are due to elevated left and right ventricular filling pressures with or without low cardiac output [1]. Heart failure symptoms typically worsen a few days (3±2.5 days) before hospital admission [2]. However, recent studies, based on continuous monitoring of intracardiac pressures (i.e. Chronicle, Medtronic Inc.) and of intrathoracic impedance (i.e. OptiVol, Medtronic Inc.), have substantially moved back the clock for the onset of AHF. Congestion (high filling pressures) progressively increases and intrathoracic fluid accumulates, starting 7-14 days before HF signs and symptoms worsen, eventually requiring urgent intravenous therapy [2,3]. What happens during the days that precede overt clinical decompensation? Can congestion itself . . . [Full Text of this Article]


   2. Compensatory mechanisms in chronic heart failure
 

   3. The endothelium in chronic heart failure
 

   4. Precipitating factors in acute heart failure
 

   5. "Systemic endothelitis" in acute heart failure
 

   6. Renal function and congestion in acute heart failure
 

   7. Cardiac function and congestion in acute heart failure
 

   8. Unifying hypothesis for the pathophysiology of acute heart failure
 

   9. Future directions
 

   10. Conclusions
 

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