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The sections in this article are: 1 Paradigmatic Shifts 2 Definition of Heart Failure 3 The Paradigm of Organ Physiology: The Failing Heart as a Defective Pump 3.1 Backward and Forward Failure 3.2 Systolic and Diastolic Dysfunction 3.3 Right and Left Heart Failure 3.4 The Neurohumoral Response in Heart Failure 3.5 Crossover Between Functional and Proliferative Signaling 3.6 Coupling Between the Failing Heart and the Circulation: Pressure–Volume Loops 3.7 Architectural Changes in the Failing Heart 4 The Paradigm of Biochemistry and Biophysics: The Failing Heart as a Weakly Contracting, Incompletely Relaxing Muscle 4.1 Inotropic and Lusitropic Abnormalities 4.2 Energy-Starvation 4.3 Molecular Alterations and Architectural Changes 5 The Paradigm of Gene Expression: The Failing Heart as an Abnormal Molecular Structure 5.1 Adaptive and Maladaptive Hypertrophy 5.2 Cardiac Myocyte Phenotypes 5.3 Shape Changes in the Cells of the Overloaded Heart 5.4 Myocardial Cell Death 6 Summary and Conclusions |
