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Ashley Brown

Eng 1201-219

Dr. Cassel

23 October 2018

Annotated Bibliography

"The longer you look back, the further you can look forward". - Sir Winston Churchill

“Clinical Characteristics and Outcomes of Young and Very Young Adults with Heart Failure:
The CHARM Programme.” Journal of the American College of Cardiology, no. 20,
2013, p. 1845. EBSCOhost, doi:10.1016/j.jacc.2013.05.072.

This study of heart failure was performed on young adults versus the typical “senior” age

group. Few studies have been performed on the effect of heart failure on the younger age groups

and is still somewhat trivial. There were 5 age groups in this study and broken down as 20-39,

40-49, 50-59, 60-69, and 70+. The youngest group of adults diagnosed with HF were typically

either obese, black in ethnicity, or born with a malfunction in their heart. Young patients are

more likely to manifest their symptoms differently as opposed to the older population, with the

youth it is not always a black and white diagnosis of HF and is often overlooked.

Younger adults seemingly have a problem following doctors’ orders because it is noted

that younger adults were more likely to be non-compliant with their medications, their diet

restrictions, as well as the necessary lifestyle changes. Despite higher hospitalization rates, the

younger age groups have been documented to have longer survival rates, but a more significant

decrease in the quality of their life. Doctors are more likely to use the more invasive procedures

to treat younger patients such as repair surgeries and ablations, as opposed to the possible

rejections the 70+ age group faces due to their weakened body states.
In its conclusion, “Compared with older patients, younger patients with HF have a

markedly different clinical profile, including a different pattern of symptoms and signs that could

lead to delayed diagnosis, a greater reduction in HRQL, more hospitalizations attributed to

nonadherence to treatment but better survival, with relatively low rates of death until the age of

60 years.”

This article was a combination of studies in multiple countries by several physicians. It

was published in the Journal of the American College of Cardiology and is directed towards

medical professionals in the field of cardiology.

Eisen, Howard. Heart Failure. [Electronic Resource] : A Comprehensive Guide to

Pathophysiology and Clinical Care. London : Springer, 2017, 2017. EBSCOhost,

This book is a glorious 843 page comprehensive guide to the heart. It covers all

possibilities, tests, and outcomes of the types of heart failure. It was edited by Howard Eisen, and

republished in 2017. In the preface of the book, it directly states “The goal of this book is to

provide an understanding of the etiologies and pathophysiology of heart failure and to provide a

context for understanding clinical therapies available for this disease. The use of this book is to

provide scientific and clinical background for trainees in cardiovascular disease as well as

physicians involved in caring for these patients. As the field continues to evolve, there will be

updates to this book to reflect these advancements.”

Due to the increase of heart related issues, increase in population age, and high medical

bill rates, HF is regularly studied to increase a patient’s mortality rate. Heart Failure can be acute

or chronic depending on its underlying causes. There are a plethora of treatment options

available to help control the underlying cause of the failure and to prolong the life of the patient.
Some of these treatment options include but are not limited to, cardiac ablations, pharmaceutical

treatments such as beta blockers and ace inhibitors, surgeries to cure blockages, fixing or

replacing valves, pacemakers to regulate a hearts rhythm, limited exercise to strengthen the heart

muscle, dietary restriction (especially decreased sodium and fluids), total heart replacement.

This book makes numerous studies and test results readily available to any physicians in

the cardiology field. It goes into great detail on the workings of the heart muscle as a whole and

the impacts of each cardiovascular diseases and the circulatory system.

KV Sahasranam. “Heart Failure Management - Evolution Over The Ages.” BMH Medical
Journal, Vol 4, Iss 1, Pp 17-22 (2017), no. 1, 2017, p. 17. EBSCOhost,

Heart failure has an extensive history and evolution of its treatments and has effected

many individuals. The earliest case of notable Heart failure was documented from a study of an

Egyptian mummy, Nebiri, who had lived over 3500 years ago. Ebners papyrus (1556-1550 BCE)

have documented some of the earliest cases of observations of heart failure symptoms.

Hippocrates (460-370 BCE) described cases of heart failure. Emperor Alexander I Comnenus

suffered from heart failure in the twelfth century as written by his daughter Anna Comnena in a

description of his symptoms.

The earliest forms of “treatment” for HF were surgical bleed outs and leeches.

Thankfully, medicine has improved throughout the centuries. The 19th century introduced that

cannula to help drain the swelling from the limbs. In 1785, a revolution in the management of

HF began with the use of the foxglove plant as a treatment option. This medical journal presents

a brief history of heart failure and its treatments and says, “Prior to 1980's the "Non
pharmacological Era" of heart failure management stressed mainly on lifestyle modification like

bed rest, positioning, restriction of fluids, digitalis and diuretics which were just coming in to the

practice of managing heart failure.”

Beta blockers were first introduced in 1975 and the trial studies of this drug directly

influenced what this article calls the “Era of Pharmacological Intervention.” Beta blockers led to

the discovery of another pharmaceutical drug called Angiotensin Converting Enzyme Inhibitors

(ACE Inhibitors or ACEIs). Next was the Angiotensin-Neprilysin inhibitors (ARNI), but due to

its serious side effects, its complications outweighed its benefits and is now rarely used.

As technology continues to develop, we start to see the use of artificial devices to aid in

the hearts function abilities. “The turn of the century saw the dawn of the "Device Era" in the

management of heart failure. Also known as "Electrophysiologic Intervention" of heart failure, it

includes, pacemakers, Cardiac Resynchronization Therapy devices (CRT) and Implantable

Cardioverter Defibrillators (ICD).” All of these devices have separate attributes to help alleviate

the stress on the heart that HF seem to cause.

Who knows where technology can take us? Just in the past 43 years technological and

pharmaceutical improvements have drastically increased the mortality of HF patients. It is well

known however, that the heart is one of those organs in our bodies that just does not improve

once the damage has been done. This is however an age of stem cell and genetic research, so

there will always be an ideal hope of a possible regeneration of one’s own heart instead of the

realistic final result of a full heart transplant, or even death.

This article was published in 2017 and is written by a medical professional, Dr. KV

Sahasranam who works as a Senior Consultant Cardiologist at Baby Memorial Hospital in India.
Also listed in this article is a way to correspond with this Doctor including the hospitals address

and his email.

Peteiro J, et al. “The Causes, Consequences, and Treatment of Left or Right Heart
Failure.” Vascular Health and Risk Management, Vol Volume 7, Pp 237-254 (2011),
2011, p. 237. EBSCOhost,

This article makes the claim that there are factors to Heart Failure including the rising age

of the population. A bad prognosis causes 65% of patients to die within 5 years after the initial

diagnosis. Heart failure patients also contribute to 1-2% of all health care costs.

The main marker to diagnose HF is done with an echo and shows the ejection fraction of

the individual. An ejection fraction (EF) is the amount of oxygenated blood the heart is able to

pump out from the lungs. An EF in a normal, healthy heart, is 70% or higher. In HF, the EF

drops to 50% or less. The main causes of heart failure listed in this journal are as follows;

myocardial ischemia, high blood pressure, cardiomyopathies, valvular heart disease, pulmonary

hypertension (PHT), and congenital heart disease. There are two main types of heart failure; right

sided and left sided. The image listed below from this medical journal breaks down the two types

of heart failure.
This article is documented in the US National Library of Medicine. It was originally

listed in a hospital university in Spain and written by medical professionals. All of the documents

I am viewing for my research project are articles written in medical journals and used for the

treatments and better understanding of heart failure as a whole.

Sossalla, Samuel, and Dirk Vollmann. “Arrhythmia-Induced Cardiomyopathy Causes, Clinical

Significance, and Treatment.” Deutsches Aerzteblatt International, vol. 115, no. 19, May
2018, pp. 334–341. EBSCOhost, doi:10.3238/arztebl.2018.0335.

Heart Failure affects 1-2% of the population and has many causes. One of these possible

causes could be due to a cardiac arrhythmia. A cardiac arrhythmia is an occurrence where your

heart is not in a normal rhythm, and can have an end result of heart failure due to the

overworking and stretching of the muscle. Think of a rubber band, the more that it is stretched

out, the less elasticity it has left in its use.

It is stated in this article that, “Cardiac arrhythmias are often a result of heart failure, but

they can cause left-ventricular systolic dysfunction (LVSD) as an arrhythmia-induced

cardiomyopathy (AIC). This causal relationship should be borne in mind by the physician

treating a patient with systolic heart failure in association with cardiac arrhythmia.” Sossalla and

Vollmann go on to say, “The underlying pathophysiologic mechanisms are incompletely

understood; the increased ventricular rate, asynchronous cardiac contractions, and neurohumoral

activation all seem to play a role.” Heart failure is still not completely understood despite the

world wide studies, as is apparent in this statement, “Together with the ever-aging population,

heart failure poses one of the greatest challenges to modern medicine and health economics.”

Heart disease, though widely studied, is still surrounded by variables that cannot seem to

be explained to the fullest extent. The studies completed in this article are done to get a better

understanding of the how and why of arrhythmia, and their direct correlation with heart failure.

An arrhythmia-induced cardiomyopathy (AIC) has different classes of arrhythmias depending on

the case of the individual. The most common arrhythmias that can trigger AIC are as follows;

atrial flutter, atrial fibrillation (also known as afib and is the most common source of an

arrhythmia), supraventricular tachycardia (SVTs), frequent premature ventricular contractions

and ventricular tachycardia (PVCs or PVTs).

To get a better understanding of heart failure, one must understand the underlying causes.

That is where the research for this article steps in. The author is giving human tested results of

one of the many causes that can lead to a heart dysfunction or failure. It is written in a medical

journal, toward an academic audience in the medical field, specifically cardiology. Published in

2018, it is up to date with the research involved for today’s world. Both authors of this article are

Doctors and professors. It offers some studies completed on individualized cases for each tier of

AICs and their end result of left-ventricular systolic dysfunction. It gives medical professionals

some insight to the course of action to complete in each instance as well as the various results
and outcomes. Unfortunately, CHF is a lifelong disease that will continue to degenerate the

heart. More often than not, the initial symptoms may be treatable, but once the damage has

started, it is hard to move backwards in the process.

This article in specific, directly correlates with a better understanding of my disease and

how it has affected my body. My FAT question is this, “What causes heart failure, and how can

it be managed?” I can utilize this current research as a great way to better understand the disease

as a whole, and how to live a healthy lifestyle after.