The investigation and treatment of chronic heart failure

Chronic heart failure (CHF) is a clinical syndrome defined by the presence of symptoms (primarily breathlessness, fatigue and fluid retention), objective evidence of cardiac dysfunction, and in cases where the diagnosis is in doubt, a response to treatment directed towards it. It is not only important to investigate to ascertain the diagnosis, but also to identify the aetiology (as this might be reversible) and to give some indication of the prognosis of the condition. The treatment of CHF has been revolutionalized by large randomized controlled clinical trials studying the effects of antagonism of the renin-angiotensin-aldosterone and sympathetic nervous systems, as well as more recently, device therapy. These therapies now form the cornerstones in the management of the condition, and prognosis for this syndrome has improved as a result. However, cardiac transplantation remains an option for patients who remain severely symptomatic, and at high risk, despite optimal medical and appropriate device therapy.