Chronic Heart Failure
Heart failure is a clinical syndrome in which a structural or functional cardiac abnormality raises filling pressures, lowers cardiac output, or both. Ejection fraction then chooses the treatment; it does not make the diagnosis.
Definition
Heart failure is a clinical syndrome of symptoms and signs caused by a structural or functional cardiac abnormality that raises intracardiac pressures, reduces cardiac output, or both. The diagnosis requires symptoms together with objective cardiac evidence, usually from echocardiography. NICE then classifies it by ejection fraction into reduced, mildly reduced and preserved categories, and that classification, not the diagnosis itself, selects the treatment.
First principles
Heart failure is a syndrome, not an ejection-fraction result
Symptoms and signs must be tied to an objective cardiac abnormality. In heart failure with reduced ejection fraction (HFrEF) the ventricle cannot empty. In heart failure with preserved ejection fraction (HFpEF) it cannot fill, so the ejection fraction reads normal while the patient is congested. N-terminal pro-B-type natriuretic peptide (NT-proBNP) decides who needs an echocardiogram and how fast; echocardiography names the phenotype and the cause.
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