ABSTRACT
Heart failure often begins insidiously, but its end stage is a lethal syndrome which affects every organ and system in the body. In most interventional studies of NYHA class III-IV heart failure, the majority of patients are dead within two years, almost always from heart failure. Despite all the advances in treatment of the past two decades, heart failure kills because it sets in train a number of physiological and chemical responses which combine into a downward spiral.1 On top of this, episodes of infection, inappropriate treatment or electrical instability can lead to ‘decompensation’, and at all stages of heart failure there is a risk of sudden death from electrical instability or new infarction.
