ABSTRACT

I. BACKGROUND A. Description of Congestive Heart Failure Congestive heart failure (CHF), a syndrome characterized by dyspnea, fatigue, and edema, is associated with many different forms of heart disease. Although ventricular diastolic dysfunction may be an important contributor to the pathophysiology of CHF, in most patients the clinical manifestations of CHF are usually asociated with decreased myocardial contractility. Functionally, CHF is characterized by decreased cardiac output ("forward failure") and increased left and right ventricular filling pressures with pulmonary congestion and edema ("backward failure"). At first these abnormalities are manifest only during exercise (i.e., failure to increase cardiac output appropriately and excessive increments in left and right ventricular pressures upon exertion), but eventually they become apparent at rest as well. Typically, in patients with CHF the ability to exercise is limited by dyspnea and fatigue. The occurrence

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