From the Guidelines
Brown heart failure cells, also known as brown atrophy cells, are cardiac myocytes that contain lipofuscin pigment, giving them a brown appearance under microscopic examination. These cells are not directly mentioned in the provided guidelines on the management of heart failure 1. However, based on general medical knowledge, brown heart failure cells develop in the hearts of patients with chronic heart failure or chronic wasting diseases. The key characteristics of these cells include:
- Cardiac myocytes that contain lipofuscin pigment
- Brown appearance under microscopic examination
- Develop in patients with chronic heart failure or chronic wasting diseases
- Result from the accumulation of lipofuscin due to chronic hypoxia and oxidative stress in failing heart tissue
- Indicate long-standing cardiac stress and are associated with myocardial atrophy
- Contribute to decreased contractile function of the heart as heart failure progresses. It is essential to note that the provided guidelines focus on the management of heart failure, including treatment of stage A heart failure by reducing modifiable risk factors, and the use of ACE inhibitors, beta blockers, and diuretics in patients with stage B or C heart failure 1. While the guidelines do not specifically address brown heart failure cells, understanding the pathophysiology of heart failure is crucial for effective management and treatment. Key points to consider in the management of heart failure include:
- Reducing modifiable risk factors, such as hypertension and hyperlipidemia
- Using ACE inhibitors and beta blockers in patients with stage B or C heart failure who have a reduced ejection fraction
- Treating patients with stage C heart failure and fluid retention with diuretics in addition to ACE inhibitors and beta blockers 1.
From the Research
Definition and Classification of Heart Failure
- Heart failure is a clinical syndrome with symptoms and/or signs caused by a structural and/or functional cardiac abnormality, corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion 2
- The universal definition of heart failure proposes revised stages of HF, including At risk for HF (Stage A), Pre-HF (Stage B), Symptomatic HF (Stage C), and Advanced HF (Stage D) 2
Pathophysiology of Heart Failure
- Heart failure is an epidemic disease that affects about 1% to 2% of the population worldwide, with varying etiology and phenotype 3
- Following a cardiac injury, cellular, structural, and neurohumoral modulations occur, influencing cell function and leading to adaptive mechanisms, volume overload, tachycardia, dyspnea, and further deterioration of cellular function 3
Treatment Options for Heart Failure
- Basic pharmacological treatment of patients with HFrEF consists of a combination of ACE inhibitors/ARNI, beta-blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors 4
- Treatment initiation of all four drug classes should be fast and simultaneous, with individualized treatment and consideration of comorbidities 4