American Heart Association classifies the chronic heart failure as follows
A. High risk for developing heart failure
- Hypertension, diabetes mellitus, CAD, family history of cardiomyopathy
B Symptomatic heart failure
- Previous MI, LV dysfunction, valvular heart disease
C Symptomatic heart failure
- Structural heart disease, dyspnea and fatigue, impaired exercise tolerance
D Refractory end-stage heart failure
- Marked symptoms at rest despite maximal medical therapy
Thus end stage heart disease is a condition in which the heart can no longer pump enough blood to fulfill the body’s metabolic requirements.
It could be of two types
- Systolic heart failure – An impairment of myocardial contractility
- Diastolic heart failure results from the left ventricle’s inability to distend normally.
The general features of CHF include pressure or volume overload, muscle loss, decreased myocardial contractility, or restrictive filling.
The following signs are associated with a particularly poor prognosis:
- Age > 55 years
- Cardiac index of < 3
- Left-ventricular end-diastolic pressure of > 20 mmHg
- Ejection fraction of < 30%
- A thin ventricular wal
- Evidence of atrial fibrillation
- Ventricular tachycardia.
Because of their high mortality, many of these patients eventually become candidates for cardiac transplantation
The term “end stage” in present era does not necessarily mean that patients would not improve. The symptoms may wax or wane and overall prognosis is poor but every patient needs to be individualized.