Gutiérrez VI, Domínguez MA

Idioma: Español
Referencias bibliográficas: 229
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RESUMEN

La falla cardiaca ha sido definida como la falla mecánica del corazón para mantener la perfusión sistémica de acuerdo con los requerimientos del metabolismo tisular.
La disfunción ventricular izquierda generalmente lleva a una falla cardiaca total, y una vez que la falla se establece la falla miocárdica y remodelación son progresivas.
Cuando el corazón es dañado por un insulto, mecanismos compensadores son activados para estabilizar la función miocárdica. Estos mecanismos a través de un aumento en la frecuencia cardiaca, contractilidad, expansión de volumen e hipertrofia, estabilizan la función del miocardio por un corto tiempo. Sin embargo, el uso crónico de esos mecanismos compensadores son el apoyo para que la falla cardiaca se establezca en forma definitiva. La activación de vías de señalización neurohumoral, citosinas y de alargamiento mecánico, alteran la expresión genética, la pérdida de miocitos cardiacos y remodelación celular, todo lo cual contribuye a la progresión de la disfunción miocárdica y remodelación representando parte de la historia natural de la falla cardiaca.
La evidencia de un aumento en la frecuencia de apoptosis ha sido detectada en falla cardiaca de pacientes sometidos a trasplantes cardiacos, así como en corazones de animales a los que se les induce en forma experimental hipertrofia y cardiomiopatía. Este artículo se enfoca en cada una de las diferentes anormalidades patofisiológicas encontradas en pacientes con severa falla cardiaca con una revisión de las investigaciones actuales sobre la patogénesis de esta condición.

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