ABSTRACT
When dealing with heart failure we think about shortness of breath, we think about decreased exercise capacity, and we think about survival. CHF usually is considered pathophysiologically as a continuum: your lungs get clear, your heart gets small, you live longer, or conversely, your lungs fill with fluid, your heart gets larger, and you die. I believe the issue is much more complex. I can foresee a situation in which the heart actually gets larger, but the patient is on amiodarone to cover electrical instability and the patient survives while the heart gets progressively larger. In addition, the periphery may be relatively more efficient in extracting O2 in some patients who, if electrically stabilized, might be the few with severe CHF who survive. I do not believe most patients with CHF fit this profile, but a number of patients do. Why they behave like this, and what we can do to treat the majority of patients to make them behave like this, is a reasonable goal of research.
