Published 9 March 2009, doi:10.1136/bmj.b961
Cite this as: BMJ 2009;338:b961

Letters

Heart failure

Heart failure is in need of a diagnosis

The first 150 words of the full text of this article appear below.

How attractive to have a syndrome where the clinical findings are "right" and the tests are "wrong." In heart failure with normal ejection fraction (HEFNEF), the presentation is consistent with heart failure but echocardiography does not fully agree. Sanderson and Yip advance that this results from predictable pathology with a well understood prognosis.¹

But the loss of rotational and longitudinal architecture occurs in other diseases such as hypertrophic cardiomyopathy long before symptoms develop. In "conventional" heart failure, the heart is enlarged and contractility is reduced, resulting in increasing breathlessness and fluid overload. Prognosis is predictably modified by drug treatment, and, although the causes are legion, the final result, a big baggy heart, is consistent.

In patients with HEFNEF the results of randomised trials have been negative or marginal,^{2 3 4} suggesting that the normal relation between preload, afterload, contractility, and prognosis does not apply—an unlikely finding in a disease continuum. Furthermore, the . . . [Full text of this article]

¹ East Sussex NHS Trust, Eastbourne District General Hospital, Eastbourne, East Sussex BN21 2UD

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