Impact of Chaos in the Progression of Heart Failure
George E. Louridas, Alexios G. Louridas

Abstract
Purpose of review: Cardiologists and researchers are well informed of the advances in chaos theory and nonlinear dynamics and their clinical application in the field of cardiology. Heart failure is a syndrome with a progressive clinical deterioration that involves left ventricular dysfunction and neurohormonal adaptations with a relentless course toward end-stage myocardial failure. In the present paper, a concept of chaotic behavior of cardiac function during heart failure progression is introduced. Recent findings: The progressive nature of heart failure discloses a dynamical and non-linear system with properties and characteristics of chaotic behavior related to the initial conditions and the presence of a chaotic attractor. The clinical deterioration of heart failure in a worse clinical state concentrates the characteristics of a complex and unstable system that is stabilized in the form of a strange (chaotic) attractor. The clinical stabilization in the form of a strange attractor is accomplished with help from the self-organized positive feedback stabilization neurohormonal mechanisms. This stabilization period is interrupted by miscellaneous causes with left ventricular remodeling being the most prominent. Summary: In human heart failure, there are periods of clinical stabilization in the form of the strange attractor that depends on its initial state, and interruption periods of clinical instability. In the interruption periods small changes of the interrupted causes can produce high clinical instability. Left ventricular remodeling with its functional myocardial deterioration is the most probable cause of the clinical decline and of the progressive nature of heart failure.

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