Healed myocardial infarction

Among the many devastating complications of healed myocardial infarction is heart failure (HF). Despite its ubiquitous role in causing death and disability around the globe, HF is quite difficult to define. It has a great deal of heterogeneity, can be acute or chronic, may involve primarily the left ventricle or right ventricle (or both), can be associated with a low or normal left ventricular ejection fraction (LVEF), and has numerous causes. This chapter focuses on HF due to chronic coronary artery disease (CAD). Virtually any form of heart disease can lead to heart failure. In general, HF is a clinical syndrome caused by structural and/or functional changes in the heart that lead to dyspnea, fatigue, and in many cases, salt and water retention. Comorbidities such as CAD, hypertension, diabetes mellitus, chronic kidney disease, or atrial fibrillation frequently accompany HF, and may contribute to or aggravate the HF syndrome. In the end, patients typically become gradually more and more disabled and eventually die prematurely from pump dysfunction or arrhythmia. Improvement in therapy the past 30 years has improved survival, but HF continues to exact a toll on patients, their families, and the worldwide economy.