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234 Heart Failure and Cor Pulmonale
Douglas L. Mann / Murali Chakinala

	Figure 234-1  Pathogenesis of heart failure with a depressed ejection fraction. Heart failure begins after an index event produces an initial decline in the heart's pumping capacity. After this initial decline in pumping capacity, a variety of compensatory mechanisms are activated, including the...
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	Figure 234-2  Activation of neurohormonal systems in heart failure. The decreased cardiac output in HF patients results in an “unloading” of high-pressure baroceptors (circles) in the left ventricle, carotid sinus, and aortic arch. This unloading of the peripheral baroreceptors leads to a...
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	Figure 234-3  Meta-analysis of angiotensin-converting enzyme (ACE) inhibitors in heart failure patients with a depressed ejection fraction. A. The Kaplan-Meier curves for mortality for 5966 HF patients with a depressed EF treated with an ACE inhibitor after acute...
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	Figure 234-4  Treatment algorithm for chronic heart failure patients with a depressed ejection fraction. After the clinical diagnosis of HF is made, it is important to treat the patient's fluid retention before starting an ACE inhibitor (or an ARB if the patient is ACE-intolerant). Beta blockers should...
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	Figure 234-5  Meta-analysis of beta blockers on mortality rates in HF patients with a depressed EF. Effect of beta blockers vs. placebo in patients who were not (A) or who were (B) receiving an angiotensin-converting enzyme (ACE) inhibitor or an...
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	Figure 234-6  Hemodynamic profiles in patients with acute heart failure. Most patients can be categorized into one of the four hemodynamic profiles by performing a brief bedside examination that includes examination of the neck veins, lungs, and peripheral extremities. More definitive hemodynamic...
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