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Advanced Systolic Heart Failure

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Heart failure with reduced ejection fraction (HFrEF) happens when the left side of the heart does not pump blood out to the body as well as normal. It is called systolic heart failure, because the left ventricle does not squeeze forcefully enough during systole, which is the phase of the heartbeat when the heart pumps blood. Systolic heart failure leads to progressive left ventricular impairment, has a poor prognosis and negatively affects the patient’s quality of life, especially when the disease advances to the point where it causes refractory symptoms.

Cardiac Arrest

Cardiac arrest is the loss of heart function, breathing and consciousness. It results from an electrical disturbance in your heart that disrupts its pumping action, stopping blood flow to the rest of your body. It is often sudden and unexpected and occurs with no warning. Symptoms are immediate and drastic and include: sudden collapse, no pulse, no breathing, loss of consciousness. Sometimes other signs and symptoms precede cardiac arrest. These may include fatigue, fainting, blackouts, dizziness, chest pain, shortness of breath, weakness, palpitations or vomiting.

Sudden Cardiac Arrest, Mayo Clinic (Mar. 7, 2018), https://www.mayoclinic.org/diseases-conditions/sudden-cardiac-arrest/symptoms-causes/syc-20350634

Class III heart failure

causes a marked limitation of physical activity. Patient symptoms include less than ordinary activity causes fatigue, palpitation, or dyspnea.


Coronary Artery Disease

CAD develops when the coronary arteries become damaged or diseased. Cholesterol-containing deposits (plaque) in the arteries and inflammation are usually to blame for CAD. When plaques build up the narrow the arteries decreasing blood flow to the heart. Eventually, the decreased blood flow may cause chest pain, shortness of breath etc. A complete blockage can cause a heart attack.



Hyperlipidemia, or high cholesterol, means that one or more fat proteins in the blood is high. It can increase the risk of developing heart disease.



Hypertension is another name for high blood pressure. It can severely impact quality of life and it increases the risk of heart disease, stroke, and death.



Hypervolemia, or fluid overload, is the medical condition where there is too much fluid in the blood. Fluid volume excess in the intravascular compartment occurs due to an increase in total body sodium content and a consequent increase in extracellular body water.



Hyponatremia refers to a low level of sodium in the blood. It may result from excess fluid in the body relative to a normal amount of sodium, or it may be due to a loss of sodium and body fluid caused by chronic conditions like kidney or congestive heart failure.

Hyponatremia (Low Blood Sodium). Medicine Net.

Mitral Valve Prolapse (MVP)

Mitral valve prolapse (MVP) occurs when the leaflets of the mitral valve bulge (prolapse) into the heart’s left upper chamber (left atrium) like a parachute during the heart’s contraction. Mitral valve prolapse sometimes leads to blood leaking backward into the left atrium, a condition called mitral valve regurgitation.

Symptoms include a racing or irregular heartbeat, dizziness or lightheadedness, difficulty breathing or shortness of breath, fatigue, chest pain not caused by a heart attack or coronary artery disease.

Mitral Valve Prolapse. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/mitral-valve-prolapse/symptoms-causes/syc-20355446

Myocardial Infarction (Heart Attack)

The heart requires its own constant supply of oxygen and nutrients. Two large, branching coronary arteries deliver oxygenated blood to the heart muscle. If one of these arteries or branches becomes blocked suddenly, a portion of the heart is starved of oxygen (cardiac ischemia). If this lasts too long, the starved heart tissue dies.


Nonischemic Cardiomyopathy

Non-Ischemic cardiomyopathy is a generic term which includes all causes of decreased heart function other than those caused by heart attacks or blockages in the arteries of the heart. Cardiomyopathy implies some decrease in normal heart function or ejection fraction to less than 50% (which is considered borderline or low normal.)


Postural Orthostatic Tachcardia Syndrome (POTS)

POTS is a form of dysautonomia. POTS is a subset of orthostatic intolerance that is associated with the presence of excessive tachycardia on standing. The current diagnostic criteria for POTS is a heart rate increase of 30 beats per minute (bpm) or more, or over 120 bpm, within the first 10 minutes of standing. POTS is often diagnosed by a Tilt Table Test, but if such testing is not available, POTS can be diagnosed with bedside measurements of heart rate and blood pressure taken in the supine (laying down) and standing up position at 2, 5 and 10 minute intervals.



Presyncope describes a feeling of lightheadedness as though one might blackout, but consciousness is preserved. The most common cause of presyncope is a sudden fall in blood pressure. Less commonly, presyncope may be caused by heart rhythm abnormalities, such as a pause in the heart beat or racing of the heart. These problems may be solely due to problems with the heart’s electrical system or associated with disease of the heart muscle or valves.

Presyncope/Syncope, Auckland Heart Group, https://www.heartgroup.co.nz/Patient+Information/Cardiac+Conditions/Adult/Adults+-+PresyncopeSyncope.html


Pulmonary Embolism

Pulmonary Embolism is blockage in one or more arteries in your lungs. In most cases, pulmonary embolism is caused by blood clots that travel to your lungs from another part of your body – most commonly, your legs. Pulmonary embolism is a complication of deep vein thrombosis (DVT), which is clotting in the veins farthest from the surface of the body. Common signs and symptoms include sudden and unexplained shortness of breath, chest pain and a cough that may bring up blood-tinged sputum.

Pulmonary Embolism, Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/pulmonary-embolism/multimedia/pulmonary-embolism/img-20006463

Pulmonary Hypertension

Pulmonary Hypertension is a type of high blood pressure that affects the arteries in the lungs and the right side of your heart. Pulmonary hypertension begins when tiny arteries in your lungs, called pulmonary arteries, and capillaries become narrowed, blocked or destroyed. This makes it harder for blood to flow through your lungs and raises pressure within your lungs’ arteries. As the pressure builds, your heart’s lower right chamber (right ventricle) must work harder to pump blood through your lungs, eventually causing your heart muscle to weaken and eventually fail. Pulmonary hypertension is a serious illness that becomes progressively worse and is sometimes fatal.

Pulmonary hypertension symptoms include: shortness of breath (dyspnea), initially while exercising and eventually while at rest; fatigue; dizziness or fainting spells (syncope); chest pressure or pain; swelling (edema) in your ankles, legs and eventually in your abdomen (ascites); bluish color to your lips and skin (cyanosis); racing pulse or heart palpitations. Pulmonary hypertension can lead to a number of complications, including: right-sided heart failure (cor pulmonale), blood clots, arrhythmia, and bleeding.

Pulmonary Hypertension, Mayo Clinic (Dec. 28, 2017), https://www.mayoclinic.org/diseases-conditions/pulmonary-hypertension/symptoms-causes/syc-20350697

Raynaud’s Syndrome

Raynaud’s is a rare disorder that affects the arteries. It is marked by brief episodes of vasospasm (narrowing of the blood vessels). Some causes included diseases and conditions that directly damage the arteries or the nerves that control the arteries in the hands and feet, repetitive actions that damage the nerves that control the arteries in the hands and feet, injuries to hands and feet, exposure to certain chemicals, and medicines that narrow the arteries or affect blood pressure.

Symptoms include body parts turning pale or white and then blue, body parts feeling numb, cold, or painful, and for body parts to turn red, tingle, burn, or feel numb as blood flow returns the affected areas. These attacks can last anywhere from a few seconds to several hours and may occur daily or weekly.

Raynaud’s. National Heart, Lung, and Blood Institute


Syncope occurs when the part of your nervous system that regulates heart rate and blood pressure malfunction in response to a trigger, such as the sight of blood. Your heart rate slows and the blood vessels in your legs widen. This allows blood to pool in your legs, which lowers your blood pressure. This drop in blood pressure and slowed heart rate quickly diminish blood flow to your brain, and you faint.

William P. Cheshire, Syncope, Mayo Clinic, https://mayoclinic.pure.elsevier.com/en/publications/syncope

i. Neurocardiogenic Syncope

Syncope is defined as a transient loss of consciousness associated with a loss of postural tone, in which the patient recovers spontaneously without the need for electrical or pharmacological cardioversion. Although frequently thought of as a condition with a neurological origin, it’s actually a cardiovascular problem-as such, a neurologic work-up is seldom rewarding.

Neurocardiogenic syncope is caused by an abnormal or exaggerated autonomic response to various stimuli, of which the most common are standing and emotion. The two main causes of syncope are cardiac arrhythmias and neurocardiogenic (vasovagal, vasodepressor) syndromes.

Carol Chen-Scarabelli and Tiziano M Scarabelli, Neurocardiogenic Syncope, NCBI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC506859/

ii. Vasovagal Syncope

Vasovagal syncope occurs when you faint because your body overreacts to certain triggers, such as the sight of blood or extreme emotional distress. The vasovagal syncope trigger causes your heart rate and blood pressure to drop suddenly. This leads to reduced blood flow to your brain, causing you to briefly lose consciousness.

Symptoms include pale skin, lightheadedness, tunnel vision, nausea, feeling warm, a cold and clammy sweat, yawning, and blurred vision. During an episode, bystanders may notice jerky, abnormal movements, a slow, weak pulse, and dilated pupils.


Vasovagal Syncope. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/vasovagal-syncope/symptoms-causes/syc-20350527


Tachycardia is a faster than normal heart rate. It occurs when an abnormality in the heart produces rapid electrical signals. In some cases, tachycardia can seriously disrupt normal heart function, increase the risk of stroke, or cause sudden cardiac arrest or death. When your heart’s rate is too rapid, it may not effectively pump blood to the rest of your body, depriving your organs and tissues of oxygen.

Symptoms of tachycardia include: dizziness, shortness of breath, lightheadedness, rapid pulse rate, heart palpitations, chest pain, and fainting. Causes of tachycardia include damage to heart tissues, abnormal electrical pathways in the heart present at birth, disease, high blood pressure, smoking, fever, too much alcohol, too much caffeine, side effects of medications, or overactive thyroid.

Tachycardia, Mayo Clinic (Mar. 8, 2018), https://www.mayoclinic.org/diseases-conditions/tachycardia/symptoms-causes/syc-20355127

Tangier’s Disease

Tangier’s Disease is an inherited disorder characterized by significantly reduced levels of high-density lipoprotein (HDL) in the blood. HDL transports cholesterol and certain fats called phospholipids from the body’s tissues to the liver, where they are removed from the blood. HDL is often referred to as “good cholesterol” because high levels of this substance reduce the chances of developing heart and blood vessel (cardiovascular) disease. Because people with Tangier disease have very low levels of HDL, they have a moderately increased risk of cardiovascular disease. Additional signs and symptoms of Tangier disease include a slightly elevated amount of fat in the blood (mild hypertriglyceridemia); disturbances in nerve function (neuropathy); and enlarged, orange-colored tonsils. Affected individuals often develop atherosclerosis, which is an accumulation of fatty deposits and scar-like tissue in the lining of the arteries. Other features of this condition may include an enlarged spleen (splenomegaly), an enlarged liver (hepatomegaly), clouding of the clear covering of the eye (corneal clouding), and type 2 diabetes.

Tangier disease. U.S. National Library of Medicine.

Tetralogy of Fallot – Congenital Heart Defect

Tetralogy of Fallot is a rare condition caused by a combination of four heart defects that are present at birth (congenital). The four abnormalities that make up the tetralogy of Fallot include pulmonary valve stenosis, ventricular septal defect, overring aorta, and right ventricular hypertrophy.

These defects cause oxygen-poor blood to flow out of the heart and to the rest of the body. Infants and children with tetralogy of Fallot usually have blue-tinged skin because their blood doesn’t carry enough oxygen. Tetralogy of Fallot is often diagnosed during infancy or soon after. However, tetralogy of Fallot might not be detected until later in some adults, depending on the severity of the defects and symptoms.

Symptoms include a bluish coloration of the skin, shortness of breath and rapid breathing, loss of consciousness, clubbing of fingers and toes, poor weight gain, tiring easily during exercise, irritability, prolonged crying, and a heart murmur.

Tetralogy of Fallot, Mayo Clinic (Mar. 9, 2018), https://www.mayoclinic.org/diseases-conditions/tetralogy-of-fallot/symptoms-causes/syc-20353477


Vasculitis is an inflammation of the blood vessels. It causes changes in the walls of blood vessels, including thickening, weakening, narrowing, and scarring. These changes restrict blood flow, resulting in organ and tissue damage. There are many types of vasculitis, and most of them are rare. Vasculitis might affect just one organ, such as the skin, or it may involve several. The condition can be short term or long lasting. Vasculitis can affect anyone, though some types are more common among certain groups. Depending on the type you have, you may improve without treatment. Or you will need medications to control the inflammation and prevent flare-ups. Vasculitis is also known as angitis and arteritis.

Symptoms include fever, headache, fatigue, weight loss, general aches and pain, night sweats, rash, nerve problems such as numbness or weakness, loss of pulse in a limb.

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