Heart failure natural history

Despite the extensive research efforts during the last 15 years, the relative contribution of apoptosis and necrosis to cell loss in heart disease remains controversial. The type of cell death in the heart often depends on the time in the natural history when it is studied necrosis is a feature of early heart failure, especially if caused by ischemia, but the cause of cell death in chronic heart failure is mainly apoptotic or autophagic [19-21], Moreover, it is possible that apoptotic and necrotic cell deaths represent two ends of continuum of response to an injury [22] cells may initially begin to die from apoptotic mechanism, but as cellular energy declines, the cells continue to die of necrosis [23],... 

Heart failure is often accompanied by other disorders whose natural history or therapy may affect morbidity and mortality. In selected patients, optimal management of these concomitant disorders may have a profound impact on heart failure symptoms and outcomes. 

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