Cardiac Remodeling

Paradigms of Heart Failure Historically heart failure (HF) has been viewed using many syndrome models.  One of the first useful models of HF was the cardio-renal model.  Clinicians viewed HF predominantly as a problem of failure of the heart and kidneys to effectively process fluid.  Low cardiac output led to poor renal perfusion, which led to excessive salt and water retention, and thus fluid overload.  In this era, diuretics and digitalis were the predominant medications available.1

It became apparent that HF was significantly related to poor cardiac pump performance and low cardiac output.  A second model of HF, the cardio-circulatory model, was introduced.  This hemodynamic model of HF emphasized

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