Heart failure
Classification and external resources
The major signs and symptoms of heart failure.
ICD-10	I50
ICD-9	428.0
DiseasesDB	16209
MedlinePlus	000158
eMedicine	med/3552 emerg/108 radio/189 med/1367150 ped/2636
MeSH	D006333

Heart failure (HF) often called congestive heart failure (CHF) or congestive cardiac failure (CCF) is generally defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body.^[1][2][3] Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition is diagnosed with echocardiography and blood tests. Treatment commonly consists of lifestyle measures (such as smoking cessation, light exercise including breathing protocols, decreased salt intake and other dietary changes) and medications. Sometimes it is treated with implanted devices (pacemakers or ventricular assist devices) and occasionally a heart transplant.

Common causes of heart failure include myocardial infarction and other forms of ischemic heart disease, hypertension, valvular heart disease, and cardiomyopathy.^[4] The term "heart failure" is sometimes incorrectly used to describe other cardiac-related illnesses, such as myocardial infarction (heart attack) or cardiac arrest, which can cause heart failure but are not equivalent to heart failure.

Heart failure is a common, costly, disabling, and potentially deadly condition.^[4] In developed countries, around 2% of adults suffer from heart failure, but in those over the age of 65, this increases to 6–10%.^[4][5]

Terminology[link]

Heart failure is a global term for the physiological state in which cardiac output is insufficient in meeting the needs of the body and lungs. Often termed "congestive heart failure" or CHF, this is most commonly caused when cardiac output is low and the body becomes congested with fluid.^[6]

It may also occur when the body's requirements for oxygen and nutrients are increased and the demand outstrips what the heart can provide, (termed "high output cardiac failure").^[7] This can occur from severe anemia, Gram negative septicaemia, beriberi (vitamin B₁/thiamine deficiency), thyrotoxicosis, Paget's disease, arteriovenous fistulae, or arteriovenous malformations.

Fluid overload is a common problem for people with heart failure but is not synonymous with it. Patients with treated heart failure will often be euvolaemic (a term for normal fluid status), or more rarely, dehydrated.

Medical professionals use the words "acute" to mean of rapid onset and "chronic" of long duration. Chronic heart failure is therefore a long term situation, usually with stable treated symptomatology.

Acute decompensated heart failure is a term used to describe exacerbated or decompensated heart failure, referring to episodes in which a patient can be characterized as having a change in heart failure signs and symptoms resulting in a need for urgent therapy or hospitalization.^[8]

There are several terms which are closely related to heart failure, and may be the cause of heart failure, but should not be confused with it:

• Cardiac arrest and asystole refer to situations in which there is no cardiac output at all. Without urgent treatment these result in sudden death.
• Myocardial infarction ("Heart attack") refers to heart muscle damage due to insufficient blood supply, usually as a result of a blocked coronary artery.
• Cardiomyopathy refers specifically to problems within the heart muscle, and these problems can result in heart failure. Ischemic cardiomyopathy implies that the cause of muscle damage is coronary artery disease. Dilated cardiomyopathy implies that the muscle damage has resulted in enlargement of the heart. Hypertrophic cardiomyopathy involves enlargement and thickening of the heart muscle.

Classification[link]

There are many different ways to categorize heart failure, including:

• the side of the heart involved (left heart failure versus right heart failure). Left heart failure compromises aortic flow to the body and brain. Right heart failure compromises pulmonic flow to the lungs. Mixed presentations are common, especially when the cardiac septum is involved.
• whether the abnormality is due to insufficient contraction (systolic dysfunction), or due to insufficient relaxation of the heart (diastolic dysfunction), or to both.
• whether the problem is primarily increased venous back pressure (preload), or failure to supply adequate arterial perfusion (afterload).
• whether the abnormality is due to low cardiac output with high systemic vascular resistance or high cardiac output with low vascular resistance (low-output heart failure vs. high-output heart failure).
• the degree of functional impairment conferred by the abnormality (as reflected in the New York Heart Association Functional Classification^[9])
• the degree of coexisting illness: i.e. heart failure/systemic hypertension, heart failure/pulmonary hypertension, heart failure/diabetes, heart failure/renal failure, etc.

Functional classification generally relies on the New York Heart Association functional classification. The classes (I-IV) are:

• Class I: no limitation is experienced in any activities; there are no symptoms from ordinary activities.
• Class II: slight, mild limitation of activity; the patient is comfortable at rest or with mild exertion.
• Class III: marked limitation of any activity; the patient is comfortable only at rest.
• Class IV: any physical activity brings on discomfort and symptoms occur at rest.

This score documents severity of symptoms, and can be used to assess response to treatment. While its use is widespread, the NYHA score is not very reproducible and doesn't reliably predict the walking distance or exercise tolerance on formal testing.^[10]

In its 2001 guidelines the American College of Cardiology/American Heart Association working group introduced four stages of heart failure:^[11]

• Stage A: Patients at high risk for developing HF in the future but no functional or structural heart disorder.
• Stage B: a structural heart disorder but no symptoms at any stage.
• Stage C: previous or current symptoms of heart failure in the context of an underlying structural heart problem, but managed with medical treatment.
• Stage D: advanced disease requiring hospital-based support, a heart transplant or palliative care.

The ACC staging system is useful in that Stage A encompasses "pre-heart failure" — a stage where intervention with treatment can presumably prevent progression to overt symptoms. ACC Stage A does not have a corresponding NYHA class. ACC Stage B would correspond to NYHA Class I. ACC Stage C corresponds to NYHA Class II and III, while ACC Stage D overlaps with NYHA Class IV.

Signs and symptoms[link]

A man with congestive heart failure and marked jugular venous distension. External jugular vein marked by an arrow.

Signs[link]

Left-sided failure[link]

Common respiratory signs are tachypnea (increased rate of breathing) and increased work of breathing (non-specific signs of respiratory distress). Rales or crackles, heard initially in the lung bases, and when severe, throughout the lung fields suggest the development of pulmonary edema (fluid in the alveoli). Cyanosis which suggests severe hypoxemia, is a late sign of extremely severe pulmonary edema.

Additional signs indicating left ventricular failure include a laterally displaced apex beat (which occurs if the heart is enlarged) and a gallop rhythm (additional heart sounds) may be heard as a marker of increased blood flow, or increased intra-cardiac pressure. Heart murmurs may indicate the presence of valvular heart disease, either as a cause (e.g. aortic stenosis) or as a result (e.g., mitral regurgitation) of the heart failure.

Right-sided failure[link]

Physical examination can reveal pitting peripheral edema, ascites, and hepatomegaly. Jugular venous pressure is frequently assessed as a marker of fluid status, which can be accentuated by eliciting hepatojugular reflux. If the right ventricular pressure is increased, a parasternal heave may be present, signifying the compensatory increase in contraction strength.

Biventricular failure[link]

Dullness of the lung fields to finger percussion and reduced breath sounds at the bases of the lung may suggest the development of a pleural effusion (fluid collection in between the lung and the chest wall). Though it can occur in isolated left- or right-sided heart failure, it is more common in biventricular failure because pleural veins drain both into the systemic and pulmonary venous system. When unilateral, effusions are often right sided.

Symptoms[link]

Heart failure symptoms are traditionally and somewhat arbitrarily divided into "left" and "right" sided, recognizing that the left and right ventricles of the heart supply different portions of the circulation. However, heart failure is not exclusively backward failure (in the part of the circulation which drains to the ventricle).

There are several other exceptions to a simple left-right division of heart failure symptoms. Left sided forward failure overlaps with right sided backward failure. Additionally, the most common cause of right-sided heart failure is left-sided heart failure. The result is that patients commonly present with both sets of signs and symptoms.

Left-sided failure[link]

Backward failure of the left ventricle causes congestion of the pulmonary vasculature, and so the symptoms are predominantly respiratory in nature. Backward failure can be subdivided into failure of the left atrium, the left ventricle or both within the left circuit. The patient will have dyspnea (shortness of breath) on exertion (dyspnée d'effort) and in severe cases, dyspnea at rest. Increasing breathlessness on lying flat, called orthopnea, occurs. It is often measured in the number of pillows required to lie comfortably, and in severe cases, the patient may resort to sleeping while sitting up. Another symptom of heart failure is paroxysmal nocturnal dyspnea a sudden nighttime attack of severe breathlessness, usually several hours after going to sleep. Easy fatigueability and exercise intolerance are also common complaints related to respiratory compromise.

"Cardiac asthma" or wheezing may occur.

Compromise of left ventricular forward function may result in symptoms of poor systemic circulation such as dizziness, confusion and cool extremities at rest.

Right-sided failure[link]

Backward failure of the right ventricle leads to congestion of systemic capillaries. This generates excess fluid accumulation in the body. This causes swelling under the skin (termed peripheral edema or anasarca) and usually affects the dependent parts of the body first (causing foot and ankle swelling in people who are standing up, and sacral edema in people who are predominantly lying down). Nocturia (frequent nighttime urination) may occur when fluid from the legs is returned to the bloodstream while lying down at night. In progressively severe cases, ascites (fluid accumulation in the abdominal cavity causing swelling) and hepatomegaly (enlargement of the liver) may develop. Significant liver congestion may result in impaired liver function, and jaundice and even coagulopathy (problems of decreased blood clotting) may occur.

Causes[link]

Chronic heart failure[link]

The predominance of causes of heart failure are difficult to analyze due to challenges in diagnosis, differences in populations, and changing prevalence of causes with age.

A 19 year study of 13000 healthy adults in the United States (the National Health and Nutrition Examination Survey (NHANES I) found the following causes ranked by Population Attributable Risk score:^[12]

1. Ischaemic heart disease 62%
2. Cigarette smoking 16%
3. Hypertension (high blood pressure)10%
4. Obesity 8%
5. Diabetes 3%
6. Valvular heart disease 2% (much higher in older populations)

An Italian registry of over 6200 patients with heart failure showed the following underlying causes:^[13]

1. Ischaemic heart disease 40%
2. Dilated cardiomyopathy 32%
3. Valvular heart disease 12%
4. Hypertension 11%
5. Other 5%

Rarer causes of heart failure include:

• Viral myocarditis (an infection of the heart muscle)
• Infiltrations of the muscle such as amyloidosis
• HIV cardiomyopathy (caused by human immunodeficiency virus)
• Connective tissue diseases such as systemic lupus erythematosus
• Abuse of drugs such as alcohol and cocaine
• Pharmaceutical drugs such as chemotherapeutic agents
• Arrhythmias

Obstructive sleep apnea a condition of sleep disordered breathing overlaps with obesity, hypertension, and diabetes and is regarded as an independent cause of heart failure.

Acute decompensated heart failure[link]

Chronic stable heart failure may easily decompensate. This most commonly results from an intercurrent illness (such as pneumonia), myocardial infarction (a heart attack), arrhythmias, uncontrolled hypertension, or a patient's failure to maintain a fluid restriction, diet, or medication.^[14] Other well recognized precipitating factors include anemia and hyperthyroidism which place additional strain on the heart muscle. Excessive fluid or salt intake, and medication that causes fluid retention such as NSAIDs and thiazolidinediones, may also precipitate decompensation.^[15]

Pathophysiology[link]

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Heart failure is caused by any condition which reduces the efficiency of the myocardium, or heart muscle, through damage or overloading. As such, it can be caused by as diverse an array of conditions as myocardial infarction (in which the heart muscle is starved of oxygen and dies), hypertension (which increases the force of contraction needed to pump blood) and amyloidosis (in which protein is deposited in the heart muscle, causing it to stiffen). Over time these increases in workload will produce changes to the heart itself:

• Reduced force of contraction, due to overloading of the ventricle. In health, increased filling of the ventricle results in increased force of contraction (by the Frank–Starling law of the heart) and thus a rise in cardiac output. In heart failure this mechanism fails, as the ventricle is loaded with blood to the point where heart muscle contraction becomes less efficient. This is due to reduced ability to cross-link actin and myosin filaments in over-stretched heart muscle.^[16]
• A reduced stroke volume, as a result of a failure of systole, diastole or both. Increased end systolic volume is usually caused by reduced contractility. Decreased end diastolic volume results from impaired ventricular filling – as occurs when the compliance of the ventricle falls (i.e. when the walls stiffen).
• Reduced spare capacity. As the heart works harder to meet normal metabolic demands, the amount cardiac output can increase in times of increased oxygen demand (e.g. exercise) is reduced. This contributes to the exercise intolerance commonly seen in heart failure. This translates to the loss of one's cardiac reserve. The cardiac reserve refers to the ability of the heart to work harder during exercise or strenuous activity. Since the heart has to work harder to meet the normal metabolic demands, it is incapable of meeting the metabolic demands of the body during exercise.
• Increased heart rate, stimulated by increased sympathetic activity^[17] in order to maintain cardiac output. Initially, this helps compensate for heart failure by maintaining blood pressure and perfusion, but places further strain on the myocardium, increasing coronary perfusion requirements, which can lead to worsening of ischemic heart disease. Sympathetic activity may also cause potentially fatal arrhythmias.
• Hypertrophy (an increase in physical size) of the myocardium, caused by the terminally differentiated heart muscle fibres increasing in size in an attempt to improve contractility. This may contribute to the increased stiffness and decreased ability to relax during diastole.
• Enlargement of the ventricles, contributing to the enlargement and spherical shape of the failing heart. The increase in ventricular volume also causes a reduction in stroke volume due to mechanical and contractile inefficiency.^[18]

The general effect is one of reduced cardiac output and increased strain on the heart. This increases the risk of cardiac arrest (specifically due to ventricular dysrhythmias), and reduces blood supply to the rest of the body. In chronic disease the reduced cardiac output causes a number of changes in the rest of the body, some of which are physiological compensations, some of which are part of the disease process:

• Arterial blood pressure falls. This destimulates baroreceptors in the carotid sinus and aortic arch which link to the nucleus tractus solitarius. This center in the brain increases sympathetic activity, releasing catecholamines into the blood stream. Binding to alpha-1 receptors results in systemic arterial vasoconstriction. This helps restore blood pressure but also increases the total peripheral resistance, increasing the workload of the heart. Binding to beta-1 receptors in the myocardium increases the heart rate and make contractions more forceful, in an attempt to increase cardiac output. This also, however, increases the amount of work the heart has to perform.
• Increased sympathetic stimulation also causes the hypothalamus to secrete vasopressin (also known as antidiuretic hormone or ADH), which causes fluid retention at the kidneys. This increases the blood volume and blood pressure.
• Reduced perfusion (blood flow) to the kidneys stimulates the release of renin – an enzyme which catalyses the production of the potent vasopressor angiotensin. Angiotensin and its metabolites cause further vasocontriction, and stimulate increased secretion of the steroid aldosterone from the adrenal glands. This promotes salt and fluid retention at the kidneys, also increasing the blood volume.
• The chronically high levels of circulating neuroendocrine hormones such as catecholamines, renin, angiotensin, and aldosterone affects the myocardium directly, causing structural remodelling of the heart over the long term. Many of these remodelling effects seem to be mediated by transforming growth factor beta (TGF-beta), which is a common downstream target of the signal transduction cascade initiated by catecholamines^[19] and angiotensin II,^[20] and also by epidermal growth factor (EGF), which is a target of the signaling pathway activated by aldosterone^[21]
• Reduced perfusion of skeletal muscle causes atrophy of the muscle fibres. This can result in weakness, increased fatigueability and decreased peak strength - all contributing to exercise intolerance.^[22]

The increased peripheral resistance and greater blood volume place further strain on the heart and accelerates the process of damage to the myocardium. Vasoconstriction and fluid retention produce an increased hydrostatic pressure in the capillaries. This shifts the balance of forces in favour of interstitial fluid formation as the increased pressure forces additional fluid out of the blood, into the tissue. This results in edema (fluid build-up) in the tissues. In right-sided heart failure this commonly starts in the ankles where venous pressure is high due to the effects of gravity (although if the patient is bed-ridden, fluid accumulation may begin in the sacral region.) It may also occur in the abdominal cavity, where the fluid build-up is called ascites. In left-sided heart failure edema can occur in the lungs - this is called cardiogenic pulmonary edema. This reduces spare capacity for ventilation, causes stiffening of the lungs and reduces the efficiency of gas exchange by increasing the distance between the air and the blood. The consequences of this are dyspnea (shortness of breath), orthopnea and paroxysmal nocturnal dyspnea.

The symptoms of heart failure are largely determined by which side of the heart fails. The left side pumps blood into the systemic circulation, whilst the right side pumps blood into the pulmonary circulation. Whilst left-sided heart failure will reduce cardiac output to the systemic circulation, the initial symptoms often manifest due to effects on the pulmonary circulation. In systolic dysfunction, the ejection fraction is decreased, leaving an abnormally elevated volume of blood in the left ventricle. In diastolic dysfunction, end-diastolic ventricular pressure will be high. This increase in volume or pressure backs up to the left atrium and then to the pulmonary veins. Increased volume or pressure in the pulmonary veins impairs the normal drainage of the alveoli and favors the flow of fluid from the capillaries to the lung parenchyma, causing pulmonary edema. This impairs gas exchange. Thus, left-sided heart failure often presents with respiratory symptoms: shortness of breath, orthopnea and paroxysmal nocturnal dyspnea.

In severe cardiomyopathy, the effects of decreased cardiac output and poor perfusion become more apparent, and patients will manifest with cold and clammy extremities, cyanosis, claudication, generalized weakness, dizziness, and syncope.

The resultant hypoxia caused by pulmonary edema causes vasoconstriction in the pulmonary circulation, which results in pulmonary hypertension. Since the right ventricle generates far lower pressures than the left ventricle (approximately 20 mmHg versus around 120 mmHg, respectively, in the healthy individual) but nonetheless generates cardiac output exactly equal to the left ventricle, this means that a small increase in pulmonary vascular resistance causes a large increase in amount of work the right ventricle must perform. However, the main mechanism by which left-sided heart failure causes right-sided heart failure is actually not well understood. Some theories invoke mechanisms that are mediated by neurohormonal activation.^[23] Mechanical effects may also contribute. As the left ventricle distends, the intraventricular septum bows into the right ventricle, decreasing the capacity of the right ventricle.

Systolic dysfunction[link]

Heart failure caused by systolic dysfunction is more readily recognized. It can be simplistically described as failure of the pump function of the heart. It is characterized by a decreased ejection fraction (less than 45%). The strength of ventricular contraction is attenuated and inadequate for creating an adequate stroke volume, resulting in inadequate cardiac output. In general, this is caused by dysfunction or destruction of cardiac myocytes or their molecular components. In congenital diseases such as Duchenne muscular dystrophy, the molecular structure of individual myocytes is affected. Myocytes and their components can be damaged by inflammation (such as in myocarditis) or by infiltration (such as in amyloidosis). Toxins and pharmacological agents (such as ethanol, cocaine, and amphetamines) cause intracellular damage and oxidative stress. The most common mechanism of damage is ischemia causing infarction and scar formation. After myocardial infarction, dead myocytes are replaced by scar tissue, deleteriously affecting the function of the myocardium. On echocardiogram, this is manifest by abnormal or absent wall motion.

Because the ventricle is inadequately emptied, ventricular end-diastolic pressure and volumes increase. This is transmitted to the atrium. On the left side of the heart, the increased pressure is transmitted to the pulmonary vasculature, and the resultant hydrostatic pressure favors extravassation of fluid into the lung parenchyma, causing pulmonary edema. On the right side of the heart, the increased pressure is transmitted to the systemic venous circulation and systemic capillary beds, favoring extravassation of fluid into the tissues of target organs and extremities, resulting in dependent peripheral edema.

Diastolic dysfunction[link]

Heart failure caused by diastolic dysfunction is generally described as the failure of the ventricle to adequately relax and typically denotes a stiffer ventricular wall. This causes inadequate filling of the ventricle, and therefore results in an inadequate stroke volume. The failure of ventricular relaxation also results in elevated end-diastolic pressures, and the end result is identical to the case of systolic dysfunction (pulmonary edema in left heart failure, peripheral edema in right heart failure.)

Diastolic dysfunction can be caused by processes similar to those that cause systolic dysfunction, particularly causes that affect cardiac remodeling.

Diastolic dysfunction may not manifest itself except in physiologic extremes if systolic function is preserved. The patient may be completely asymptomatic at rest. However, they are exquisitely sensitive to increases in heart rate, and sudden bouts of tachycardia (which can be caused simply by physiological responses to exertion, fever, or dehydration, or by pathological tachyarrhythmias such as atrial fibrillation with rapid ventricular response) may result in flash pulmonary edema. Adequate rate control (usually with a pharmacological agent that slows down AV conduction such as a calcium channel blocker or a beta-blocker) is therefore key to preventing decompensation.

Left ventricular diastolic function can be determined through echocardiography by measurement of various parameters such as the E/A ratio (early-to-atrial left ventricular filling ratio), the E (early left ventricular filling) deceleration time, and the isovolumic relaxation time.

Diagnosis[link]

Acute pulmonary edema. Note enlarged heart size, apical vascular redistribution ( circle ), and small bilateral pleural effusions ( arrow ).

No system of diagnostic criteria has been agreed as the gold standard for heart failure. Commonly used systems are the "Framingham criteria"^[24] (derived from the Framingham Heart Study), the "Boston criteria",^[25] the "Duke criteria",^[26] and (in the setting of acute myocardial infarction) the "Killip class".^[27]

Imaging[link]

Echocardiography is commonly used to support a clinical diagnosis of heart failure. This modality uses ultrasound to determine the stroke volume (SV, the amount of blood in the heart that exits the ventricles with each beat), the end-diastolic volume (EDV, the total amount of blood at the end of diastole), and the SV in proportion to the EDV, a value known as the ejection fraction (EF). In pediatrics, the shortening fraction is the preferred measure of systolic function. Normally, the EF should be between 50% and 70%; in systolic heart failure, it drops below 40%. Echocardiography can also identify valvular heart disease and assess the state of the pericardium (the connective tissue sac surrounding the heart). Echocardiography may also aid in deciding what treatments will help the patient, such as medication, insertion of an implantable cardioverter-defibrillator or cardiac resynchronization therapy. Echocardiography can also help determine if acute myocardial ischemia is the precipitating cause, and may manifest as regional wall motion abnormalities on echo.

Chest X-rays are frequently used to aid in the diagnosis of CHF. In the compensated patient, this may show cardiomegaly (visible enlargement of the heart), quantified as the cardiothoracic ratio (proportion of the heart size to the chest). In left ventricular failure, there may be evidence of vascular redistribution ("upper lobe blood diversion" or "cephalization"), Kerley lines, cuffing of the areas around the bronchi, and interstitial edema.

Electrophysiology[link]

An electrocardiogram (ECG/EKG) may be used to identify arrhythmias, ischemic heart disease, right and left ventricular hypertrophy, and presence of conduction delay or abnormalities (e.g. left bundle branch block). Although these findings are not specific to the diagnosis of heart failure a normal ECG virtually excludes left ventricular systolic dysfunction.^[28]

Blood tests[link]

Blood tests routinely performed include electrolytes (sodium, potassium), measures of renal function, liver function tests, thyroid function tests, a complete blood count, and often C-reactive protein if infection is suspected. An elevated B-type natriuretic peptide (BNP) is a specific test indicative of heart failure. Additionally, BNP can be used to differentiate between causes of dyspnea due to heart failure from other causes of dyspnea. If myocardial infarction is suspected, various cardiac markers may be used.

According to a meta-analysis comparing BNP and N-terminal pro-BNP (NTproBNP) in the diagnosis of heart failure, BNP is a better indicator for heart failure and left ventricular systolic dysfunction. In groups of symptomatic patients, a diagnostic odds ratio of 27 for BNP compares with a sensitivity of 85% and specificity of 84% in detecting heart failure.^[29]

Angiography[link]

Heart failure may be the result of coronary artery disease, and its prognosis depends in part on the ability of the coronary arteries to supply blood to the myocardium (heart muscle). As a result, coronary catheterization may be used to identify possibilities for revascularisation through percutaneous coronary intervention or bypass surgery.

Monitoring[link]

Various measures are often used to assess the progress of patients being treated for heart failure. These include fluid balance (calculation of fluid intake and excretion), monitoring body weight (which in the shorter term reflects fluid shifts).

Algorithms[link]

There are various algorithms for the diagnosis of heart failure. For example, the algorithm used by the Framingham Heart Study adds together criteria mainly from physical examination. In contrast, the more extensive algorithm by the European Society of Cardiology (ESC) weights the difference between supporting and opposing parameters from the medical history, physical examination, further medical tests as well as response to therapy.

Framingham criteria[link]

By the Framingham criteria, diagnosis of congestive heart failure (heart failure with impaired pumping capability)^[6] requires the simultaneous presence of at least 2 of the following major criteria or 1 major criterion in conjunction with 2 of the following minor criteria:

Major criteria:^[30]

• Cardiomegaly on chest radiography
• S3 gallop (a third heart sound)
• Acute pulmonary edema
• Paroxysmal nocturnal dyspnea
• Crackles on lung auscultation
• Central venous pressure of more than 16 cm H2O at the right atrium
• Jugular vein distension
• Positive abdominojugular test
• Weight loss of more than 4.5 kg in 5 days in response to treatment (sometimes classified as a minor criterium^[31])

Minor criteria:^[30]

• Tachycardia of more than 120 beats per minute
• Nocturnal cough
• Dyspnea on ordinary exertion
• Pleural effusion
• Decrease in vital capacity by one third from maximum recorded
• Hepatomegaly
• Bilateral ankle edema

Minor criteria are acceptable only if they can not be attributed to another medical condition such as pulmonary hypertension, chronic lung disease, cirrhosis, ascites, or the nephrotic syndrome.^[30] The Framingham Heart Study criteria are 100% sensitive and 78% specific for identifying persons with definite congestive heart failure.^[30]

ESC algorithm[link]

The ESC algorithm weights the following parameters in establishing the diagnosis of heart failure:^[32]

Management[link]

Treatment focuses on improving the symptoms and preventing the progression of the disease. Reversible causes of the heart failure also need to be addressed: (e.g. infection, alcohol ingestion, anemia, thyrotoxicosis, arrhythmia, hypertension). Treatments include lifestyle and pharmacological modalities.

Acute decompensation[link]

In acute decompensated heart failure (ADHF), the immediate goal is to re-establish adequate perfusion and oxygen delivery to end organs. This entails ensuring that airway, breathing, and circulation are adequate. Immediated treatments usually involve some combination of vasodilators such as nitroglycerin, diuretics such as furosemide, and possibly non invasive positive pressure ventilation (NIPPV).

Chronic management[link]

The goal is to prevent the development of acute decompensated heart failure, to counteract the deleterious effects of cardiac remodeling, and to minimize the symptoms that the patient suffers. First-line therapy for all heart failure patients is angiotensin-converting enzyme (ACE) inhibition. ACE inhibitors (i.e., enalapril, captopril, lisinopril, ramipril) improve survival and quality of life in heart failure patients, and have been shown to reduce mortality in patients with left ventricular dysfunction in numerous randomized trials.^[33][34] In addition to pharmacologic agents (oral loop diuretics, beta-blockers, ACE inhibitors or angiotensin receptor blockers, vasodilators, and in severe cardiomyopathy aldosterone receptor antagonists), behavioral modification should be pursued, specifically with regard to dietary guidelines regarding salt and fluid intake. Exercise should be encouraged as tolerated, as sufficient conditioning can significantly improve quality-of-life.

In patients with severe cardiomyopathy, implantation of an automatic implantable cardioverter defibrillator (AICD) should be considered. A select population will also probably benefit from ventricular resynchronization.

In select cases, cardiac transplantation can be considered. While this may resolve the problems associated with heart failure, the patient generally must remain on an immunosuppressive regimen to prevent rejection, which has its own significant downsides.

Home dobutamine and milrinone[link]

These two medications are both inotropes with sympathomimetic effect. Both can be used in severe heart failure, generally in patients who require frequent exacerbations with hospitalization and/or refractory symptoms. While both medications have proven to improve symptoms, both also increase the risk of sudden cardiac death, and the research suggests an increased mortality rate for patients who are started on these medications. Extensive counseling about symptom management vs. risk of earlier death needs to be undertaken before starting the medication.^{[citation needed]}

Palliative care[link]

Patients with CHF often have significant symptoms, such as shortness of breath and chest pain. Both palliative care and cardiology are trying to get palliative care involved earlier in the course of patients with heart failure, and some would argue any patient with NYHA class III CHF should have a palliative care referral. Palliative care can not only provide symptom management, but also assist with advanced care planning, goals of care in the case of a significant decline, and making sure the patient has a medical power of attorney and discussed his or her wishes with this individual.

Hospice[link]

Without transplantation, heart failure may not be reversible and cardiac function typically deteriorates with time. The growing number of patients with Stage IV heart failure (intractable symptoms of fatigue, shortness of breath or chest pain at rest despite optimal medical therapy) should be considered for palliative care or hospice, according to American College of Cardiology/American Heart Association guidelines.

Prognosis[link]

Prognosis in heart failure can be assessed in multiple ways including clinical prediction rules and cardiopulmonary exercise testing. Clinical prediction rules use a composite of clinical factors such as lab tests and blood pressure to estimate prognosis. Among several clinical prediction rules for prognosing acute heart failure, the 'EFFECT rule' slightly outperformed other rules in stratifying patients and identifying those at low risk of death during hospitalization or within 30 days.^[35] Easy methods for identifying low risk patients are:

• ADHERE Tree rule indicates that patients with blood urea nitrogen < 43 mg/dl and systolic blood pressure at least 115 mm Hg have less than 10% chance of inpatient death or complications.
• BWH rule indicates that patients with systolic blood pressure over 90 mm Hg, respiratory rate of 30 or less breaths per minute, serum sodium over 135 mmol/L, no new ST-T wave changes have less than 10% chance of inpatient death or complications.

A very important method for assessing prognosis in advanced heart failure patients is cardiopulmonary exercise testing (CPX testing). CPX testing is usually required prior to heart transplantation as an indicator of prognosis. Cardiopulmonary exercise testing involves measurement of exhaled oxygen and carbon dioxide during exercise. The peak oxygen consumption (VO2 max) is used as an indicator of prognosis. As a general rule, a VO2 max less than 12-14 cc/kg/min indicates a poor survival and suggests that the patient may be a candidate for a heart transplant. Patients with a VO2 max<10 cc/kg/min have clearly poorer prognosis. The most recent International Society for Heart and Lung Transplantation (ISHLT) guidelines^[36] also suggest two other parameters that can be used for evaluation of prognosis in advanced heart failure, the heart failure survival score and the use of a criterion of VE/VCO2 slope > 35 from the CPX test. The heart failure survival score is a score calculated using a combination of clinical predictors and the VO2 max from the cardiopulmonary exercise test.

Epidemiology[link]

Mostly as a result of the costs of hospitalization, it is associated with a high health expenditure; costs have been estimated to amount to 2% of the total budget of the National Health Service in the United Kingdom, and more than $35 billion in the United States.^[37][38] Heart failure is associated with significantly reduced physical and mental health, resulting in a markedly decreased quality of life.^[39][40] With the exception of heart failure caused by reversible conditions, the condition usually worsens with time. Although some people survive many years, progressive disease is associated with an overall annual mortality rate of 10%.^[41]

Heart failure is the leading cause of hospitalization in people older than 65.^[42] In developed countries, the mean age of patients with heart failure is 75 years old. In developing countries, two to three percent of the population suffers from heart failure, but in those 70 to 80 years old, it occurs in 20—30 percent.

Heart failure affects close to 5 million people in the USA and each year close to 500,000 new cases are diagnosed. What is of more concern is that more than 50% of patients seek re-admission within 6 months after treatment and the average duration of hospital stay is 6 days.

In tropical countries, the most common cause of HF is valvular heart disease or some type of cardiomyopathy. Moreover as underdeveloped countries become more affluent, there has also been an increase in diabetes, hypertension and obesity which has resulted in heart failure.

In USA, HF is much higher in African Americans, Hispanics, Native Americans and recent immigrants from the eastern bloc countries like Russia. This high prevalence in these ethnic populations has been linked to high incidence of diabetes and hypertension. In many new immigrants to the USA the high prevalence of heart failure has largely been attributed to lack of preventive health care or substandard treatment.^[43]

Sex[link]

Men have a higher incidence of heart failure, but the overall prevalence rate is similar in both sexes, since women survive longer after the onset of heart failure.^[44] Women tend to be older when diagnosed with heart failure (after menopause), they are more likely than men to have diastolic dysfunction, and seem to experience a lower overall quality of life than men after diagnosis.^[44]

Race[link]

New information suggests that elements of heart failure in African Americans and Caucasians may be different^[45] and therapy for heart failure has different efficacies depending on racial, ethnic, and genetic backgrounds.

References[link]

External links[link]

Wikimedia Commons has media related to: Heart failure

• American Heart Association's Heart Failure web site - information and resources for treating and living with heart failure.
• Heart Failure Matters – patient information website of the Heart Failure Association of the European Society of Cardiology

Dave Brubeck
Dave Brubeck at the White House for the 2009 Kennedy Center Honors
Background information
Birth name	David Warren Brubeck
Born	(1920-12-06) December 6, 1920 (age 91) Concord, California United States
Genres	Jazz Cool jazz West Coast jazz Third stream
Occupations	Pianist Composer Bandleader
Instruments	Piano
Years active	1940s–present
Associated acts	Dave Brubeck Quartet

David Warren "Dave" Brubeck (born December 6, 1920) is an American jazz pianist. He has written a number of jazz standards, including "In Your Own Sweet Way" and "The Duke". Brubeck's style ranges from refined to bombastic, reflecting his mother's attempts at classical training and his improvisational skills. His music is known for employing unusual time signatures, and superimposing contrasting rhythms, meters, and tonalities.

His long-time musical partner, alto saxophonist Paul Desmond, wrote the Dave Brubeck Quartet's best remembered piece, "Take Five",^[1] which is in 5/4 time and has endured as a jazz classic on the top-selling jazz album, Time Out.^[2] Brubeck experimented with time signatures throughout his career, recording "Pick Up Sticks" in 6/4, "Unsquare Dance" in 7/4, and "Blue Rondo à la Turk" in 9/8. He is also a respected composer of orchestral and sacred music, and wrote soundtracks for television such as Mr. Broadway and the animated mini-series This Is America, Charlie Brown.

Early life and career[link]

Brubeck was born in Concord, California^[1] and grew up in Ione. He is of English (maternal), Swiss and possibly Native American Modoc Tribe ^[3] multi-ethnic (paternal) ancestry^[4] His father, Howard "Pete" Brubeck, was a cattle rancher, and his mother, Elizabeth (née Ivey), who had studied piano in England under Myra Hess and intended to become a concert pianist, taught piano for extra money.^[5] Brubeck originally did not intend to become a musician (his two older brothers, Henry and Howard, were already on that track), but took lessons from his mother. He could not read sheet music during these early lessons, attributing this difficulty to poor eyesight, but "faked" his way through, well enough that this deficiency went mostly unnoticed.^[6]

Intending to work with his father on their ranch, Brubeck entered the College of the Pacific (now the University of the Pacific) studying veterinary science, but transferred on the urging of the head of zoology, Dr. Arnold, who told him "Brubeck, your mind's not here. It's across the lawn in the conservatory. Please go there. Stop wasting my time and yours".^[7] Later, Brubeck was nearly expelled when one of his professors discovered that he could not read music. Several of his professors came forward, arguing that his ability with counterpoint and harmony more than compensated. The college was still afraid that it would cause a scandal, and agreed to let Brubeck graduate only after he promised never to teach piano.^[8]

After graduating in 1942, Brubeck was drafted into the army and served overseas in George Patton's Third Army. He was spared from service in the Battle of the Bulge when he volunteered to play piano at a Red Cross show; he was such a hit he was ordered to form a band. Thus he created one of the US armed forces' first racially integrated bands, "The Wolfpack".^[8] While serving in the military, Brubeck met Paul Desmond in early 1944.^[9] He returned to college after serving nearly four years in the army, this time attending Mills College and studying under Darius Milhaud, who encouraged him to study fugue and orchestration, but not classical piano. While on active duty, he received two lessons from Arnold Schoenberg at UCLA in an attempt to connect with High Modernism theory and practice.^[10] However, the encounter did not end on good terms since Schoenberg believed that every note should be accounted for, an approach which Brubeck could not accept.

After completing his studies under Milhaud, Brubeck helped to establish Berkeley, California's Fantasy Records. He worked with an octet (the recording bears his name only because Brubeck was the best-known member at the time), and a trio including Cal Tjader and Ron Crotty. Highly experimental, the group made few recordings and got even fewer paying jobs. The trio was often joined by Paul Desmond on the bandstand, at Desmond's prodding.^[11]

Quartet era[link]

Following a near-fatal swimming accident which incapacitated him for several months, Brubeck organized The Dave Brubeck Quartet in 1951, with Desmond on saxophone. They took up a long residency at San Francisco's Black Hawk nightclub and gained great popularity touring college campuses, recording a series of albums with such titles as Jazz at Oberlin (1953), Jazz at College of the Pacific (1953), and Brubeck's debut on Columbia Records, Jazz Goes to College (1954). In that same year, he was featured on the cover of Time magazine, the second jazz musician to be so honored (the first was Louis Armstrong on February 21, 1949^[13]). Brubeck personally found this accolade embarrassing since he considered Duke Ellington more deserving of it and was convinced that himself being Caucasian as opposed to Ellington being African American was a factor for why he was favored.^[14]

Early bassists for the group included Ron Crotty, Bob Bates, and Bob's brother Norman Bates; Lloyd Davis and Joe Dodge held the drum chair. In 1956, Brubeck hired Joe Morello, who had been working with Marian McPartland; Morello's presence made possible the rhythmic experiments that were to come. In 1958 Eugene Wright joined for the group's US State Department tour of Europe and Asia. Wright became a permanent member in 1959, making the "classic" Quartet's personnel complete. Wright, however, is African-American. During the late 1950s and early 1960s Brubeck canceled several concerts because the club owners or hall managers continued to resisted the idea of an integrated band on their stages. He also canceled a television appearance when he found out that the producers intended to keep Wright off-camera.{Citation needed|date=May 2012}}

In 1959, the Dave Brubeck Quartet recorded Time Out, an album their label was enthusiastic about but nonetheless hesitant to release. Featuring the album art of S. Neil Fujita, the album contained all original compositions, almost none of which were in common time: 9/8, 5/4, 3/4, and 6/4 were used inspired by Eurasian folk music they experienced during that US State Department sponsored tour.^[15] Nonetheless, on the strength of these unusual time signatures (the album included "Take Five", "Blue Rondo à la Turk", and "Three To Get Ready"), it quickly went platinum.

Dave Brubeck Quartet 1967. From left to right: Joe Morello, Eugene Wright, Brubeck and Paul Desmond.

Time Out was followed by several albums with a similar approach, including Time Further Out: Miro Reflections (1961), using more 5/4, 6/4, and 9/8, plus the first attempt at 7/4; Countdown: Time in Outer Space (dedicated to John Glenn) (1962), featuring 11/4 and more 7/4; and Time Changes (1963), with much 3/4, 10/4 (which was really 5+5), and 13/4. These albums were also known for using contemporary paintings as cover art, featuring the work of Joan Miró on Time Further Out, Franz Kline on Time in Outer Space, and Sam Francis on Time Changes.

A high point for the group was their 1963 live album At Carnegie Hall, described by critic Richard Palmer as "arguably Dave Brubeck's greatest concert".

In the early 1960s, Brubeck and his wife Iola developed a jazz musical, The Real Ambassadors, based in part on experiences they and their colleagues had during foreign tours on behalf of the US State Department. The soundtrack album, which featured Louis Armstrong, Lambert, Hendricks & Ross, and Carmen McRae was recorded in 1961; the musical itself was performed at the 1962 Monterey Jazz Festival.

At their peak in the early '60s, the Brubeck Quartet was releasing as many as four albums a year. Apart from the 'College' and the 'Time' series, Brubeck recorded four LPs featuring his compositions based on the group's travels, and the local music they encountered. Jazz Impressions of the USA (1956, Morello's debut with the group), Jazz Impressions of Eurasia (1958), Jazz Impressions of Japan (1964), and Jazz Impressions of New York (1964) are less well-known albums, but all are brilliant examples of the quartet's studio work, and they produced Brubeck standards such as "Summer Song," "Brandenburg Gate," "Koto Song," and "Theme From Mr. Broadway." (Brubeck wrote, and the Quartet performed, the theme song for the Craig Stevens CBS drama series; the music from the series became material for the "New York" album.)

In 1961 Dave Brubeck appeared in a few scenes of the British Jazz/Beat film All Night Long, which starred Patrick McGoohan and Richard Attenborough. Brubeck merely plays himself, and his piano playing includes closeups of his fingerings. Brubeck performs "It's a Raggy Waltz" from the Time Further Out album and duets briefly with bassist Charles Mingus in "Non-Sectarian Blues".

In the early 1960s Dave Brubeck was the program director of WJZZ-FM radio (now WEZN). He achieved his vision of an all jazz format radio station along with his friend and neighbor John E. Metts, one of the first African Americans in senior radio management.

The final studio album for Columbia by the Desmond/Wright/Morello quartet was Anything Goes (1966) featuring Cole Porter songs. A few concert recordings followed, and The Last Time We Saw Paris (1967) was the "Classic" Quartet's swansong.

Later career[link]

Brubeck in a 1972 performance in Hamburg

Brubeck's disbanding of the Quartet at the end of 1967 allowed him more time to compose the longer, extended orchestral and choral works that were occupying his attention (to say nothing of Brubeck's desire to spend more time with his family). February 1968 saw the premiere of The Light in the Wilderness for baritone solo, choir, organ, the Cincinnati Symphony Orchestra conducted by Erich Kunzel, and Brubeck improvising on certain themes within. The piece is an oratorio on Jesus's teachings. The next year, Brubeck produced The Gates of Justice, a cantata mixing Biblical scripture with the words of Dr. Martin Luther King, Jr.

Personal life[link]

Four of Brubeck's six children are professional musicians. Darius, the eldest, is an accomplished pianist, producer, educator and performer. (He was named after Dave Brubeck's mentor Darius Milhaud.^[16]) Dan is a renowned percussionist, Chris is a multi-instrumentalist and composer. Matthew, the youngest, is a versatile cellist with an impressive list of composing and performance credits. Brubeck's children often join with him in concerts and in the recording studio.

Brubeck in 2005

Brubeck believed what he saw during World War II contradicted the Ten Commandments, and the war evoked a spiritual awakening.^{[citation needed]} He became a Catholic in 1980, shortly after completing the Mass To Hope which had been commissioned by Ed Murray, editor of the national Catholic weekly Our Sunday Visitor. Although he had spiritual interests before that time, he said, "I didn't convert to Catholicism, because I wasn't anything to convert from. I just joined the Catholic Church."^[17] In 1996, he received the Grammy Lifetime Achievement Award. In 2006, Brubeck was awarded the University of Notre Dame's Laetare Medal, the oldest and most prestigious^[18] honor given to American Catholics, during the University's commencement. He performed "Travellin' Blues" for the graduating class of 2006.

Brubeck founded the Brubeck Institute with his wife Iola at their alma mater, the University of the Pacific in 2000. What began as a special archive, consisting of the personal document collection of the Brubecks has since expanded to provide fellowships and educational opportunities in jazz for students, also leading to having one of the main streets the school resides on named in his honor, Dave Brubeck Way.^[19]

Recognition[link]

Dave Brubeck (third from left), amongst Kennedy Center honorees 2009, flanked by President and Mrs. Obama at the Blue Room, White House, December 6, 2009.

On April 8, 2008, United States Secretary of State Condoleezza Rice presented Brubeck with a "Benjamin Franklin Award for Public Diplomacy" for offering an American "vision of hope, opportunity and freedom" through his music.^[20] "As a little girl I grew up on the sounds of Dave Brubeck because my dad was your biggest fan," said Rice.^[21] The State Department said in a statement that "as a pianist, composer, cultural emissary and educator, Dave Brubeck's life's work exemplifies the best of America's cultural diplomacy."^[20] At the ceremony Brubeck played a brief recital for the audience at the State Department.^[20] "I want to thank all of you because this honor is something that I never expected. Now I am going to play a cold piano with cold hands," Brubeck stated.^[20]

California Governor Arnold Schwarzenegger and First Lady Maria Shriver announced on May 28, 2008 that Brubeck would be inducted into the California Hall of Fame, located at The California Museum for History, Women and the Arts. The induction ceremony occurred December 10, and he was inducted alongside eleven other legendary Californians.^[22]

In September 2009, the Kennedy Center for the Performing Arts announced Brubeck as a Kennedy Center Honoree for exhibiting excellence in performance arts.^[23] The Kennedy Center Honors Gala took place on Sunday, December 6 (Brubeck's 89th birthday) and was broadcast nationwide on CBS on December 29 at 9:00 pm EST.

On September 20, 2009, at Monterey Jazz Festival, Brubeck was awarded an honorary Doctor of Music degree (D.Mus. honoris causa) from Berklee College of Music.^[24]

On May 16, 2010, Brubeck was awarded an honorary Doctor of Music degree (honoris causa) from The George Washington University in Washington, DC. The ceremony took place on the National Mall.^{[citation needed]}

On July 5, 2010, Brubeck was awarded the Miles-Davis Award at the Montreal International Jazz Festival.^{[citation needed]}In 2010, Bruce Ricker and Clint Eastwood produced a documentary Dave Brubeck: In His Own Sweet Way about Brubeck for Turner Classic Movies (TCM) to commemorate his 90th birthday in December 2010.^[25]

Brubeck has become a supporter of the Jazz Foundation of America in their mission to save the homes and the lives of elderly jazz and blues musicians, including musicians that survived Hurricane Katrina.^[26] Brubeck supported the Jazz Foundation by performing in their annual benefit concert "A Great Night in Harlem" in 2006.^[27]

Awards[link]

• Connecticut Arts Award (1987)
• National Medal of Arts, National Endowment for the Arts (1994)
• DownBeat Hall of Fame (1994)
• Grammy Lifetime Achievement Award (1996)
• Doctorate honoris causa University of Fribourg, Switzerland (2004)
• Laetare Medal (University of Notre Dame) (2006)
• BBC Jazz Lifetime Achievement Award (2007)
• Benjamin Franklin Award for Public Diplomacy (2008)^[20]
• Inducted into California Hall of Fame (2008)
• Kennedy Centre Honour (2009)^[28]
• George Washington University Honorary Degree (2010)^[29]
• Honorary Fellow of Westminster Choir College, Princeton, New Jersey (2011)

Discography[link]

• Brubeck Trio with Cal Tjader, Volume 1 (1949)
• Brubeck Trio with Cal Tjader, Volume 2 (1949)
• Brubeck/Desmond (1951)
• Stardust (1951)
• Dave Brubeck Quartet (1951)
• Jazz at the Blackhawk (1952)
• Dave Brubeck/Paul Desmond (1952)
• Jazz at Storyville (live) (1952)
• featuring Paul Desmond In Concert (live) (1953)
• Two Knights at the Black Hawk (1953)
• Jazz at Oberlin (1953) Fantasy Records
• Dave Brubeck & Paul Desmond at Wilshire Ebell (1953)
• Jazz at the College of the Pacific (1953) Fantasy Records
• Jazz Goes to College (1954) Columbia Records
• Dave Brubeck at Storyville 1954 (live) (1954)
• Brubeck Time (1955)
• Jazz: Red Hot And Cool (1955)
• Brubeck Plays Brubeck (1956)
• Dave Brubeck and Jay & Kai at Newport (1956)
• Jazz Impressions of the U.S.A. (1956)
• Plays and Plays and... (1957) Fantasy Records
• Reunion (1957) Fantasy Records
• Jazz Goes to Junior College (live) (1957)
• Dave Digs Disney (1957)
• In Europe (1958)
• Complete 1958 Berlin Concert (released 2008)
• Newport 1958
• Jazz Impressions of Eurasia (1958)
• Gone with the Wind (1959) Columbia Records
• Time Out (1959) Columbia Records/Legacy (RIAA: Platinum)
• Southern Scene (1960)
• The Riddle (1960)
• Brubeck and Rushing (1960)
• Brubeck a la Mode (1961) Fantasy Records
• Tonight Only with the Dave Brubeck Quartet (1961, with Carmen McRae)
• Take Five Live (1961, Live, Columbia Records, with Carmen McRae, released 1965)
• Near-Myth (1961) Fantasy Records
• Bernstein Plays Brubeck Plays Bernstein (1961)
• Time Further Out (1961) Columbia Records/Legacy
• Countdown—Time in Outer Space (1962) Columbia Records
• The Real Ambassadors (1962)
• Music From West Side Story (1962)
• Bossa Nova U.S.A. (1962)
• Brubeck in Amsterdam (1962, released 1969)
• Brandenburg Gate: Revisited (1963) Columbia Records
• At Carnegie Hall (1963)
• Time Changes (album) (1963)
• Dave Brubeck in Berlin (1964)
• Jazz Impressions of Japan (1964) Columbia Records/Legacy
• Jazz Impressions of New York (1964) Columbia Records/Legacy
• Angel Eyes (1965)
• My Favorite Things (1965)
• The 1965 Canadian Concert (released 2008)
• Time In (1966) Columbia Records
• Anything Goes (1966)
• Bravo! Brubeck! (1967)
• Buried Treasures (1967, released 1998)
• Jackpot (1967) Columbia Records
• The Last Time We Saw Paris (1968)
• Adventures in Time (Compilation, 1972) Columbia Records
• The Light in the Wilderness (1968)
• Compadres (1968)
• Blues Roots (1968)
• Brubeck/Mulligan/Cincinnati (1970)
• Live at the Berlin Philharmonie (1970)
• The Last Set at Newport (1971) Atlantic Records
• Truth is Fallen (1972)
• We're All Together Again For the First Time (1973)
• Two Generations of Brubeck (1973)
• Brother, the Great Spirit Made Us All (1974)
• All The Things We Are (1974)
• Brubeck & Desmond 1975: The Duets
• DBQ 25th Anniversary Reunion (1976) A&M Records
• The New Brubeck Quartet Live at Montreux (1978)
• A Cut Above (1978)
• La Fiesta de la Posada (1979)
• Back Home (1979) Concord Records
• A Place in Time (1980)
• Tritonis (1980) Concord Records
• To Hope! A Celebration By Dave Brubeck (A Mass in the Revised Roman Ritual) - Original now out-of-print 1980 recording conducted by Erich Kunzel. Pastoral Arts Associates (PAA) of North America, Old Hickory, Nashville, Tennesses 37187 LP record number DRP-8318. Music Copyright 1979 St. Francis Music. Recording Copyright 1980 Our Sunday Visitor, Inc.
• Paper Moon (1982) Concord Records
• Concord on a Summer Night (1982)
• For Iola (1984)
• Marian McPartland's Piano Jazz with guest Dave Brubeck (1984, released 1993)
• Reflections (1985)
• Blue Rondo (1986)
• Moscow Night (1987)
• New Wine (1987, released 1990)
• The Great Concerts (Compilation, 1988)
• Quiet As The Moon (Charlie Brown soundtrack) (1991)
• Once When I Was Very Young (1991)
• Time Signatures: A Career Retrospective (Compilation, 1992) Sony Colombia Legacy
• Trio Brubeck (1993)
• Late Night Brubeck (1994)
• Just You, Just Me (solo) (1994)
• Nightshift (1995)
• Young Lions & Old Tigers (1995)
• To Hope! A Celebration (1996)
• A Dave Brubeck Christmas (1996)
• In Their Own Sweet Way (1997)
• So What's New? (1998)
• The 40th Anniversary Tour of the U.K. (1999)
• One Alone (2000)
• Double Live From the USA & UK (2001)
• The Crossing (2001)
• Vocal Encounters (Compilation, 2001) Sony Records
• Classical Brubeck (with the London Symphony Orchestra, 2003) Telarc
• Park Avenue South (2003)
• The Gates of Justice (2004)
• Private Brubeck Remembers (solo piano + Interview disc w. Walter Cronkite) (2004)
• London Flat, London Sharp (2005) Telarc
• Indian Summer (2007) Telarc
• Live at the Monterey Jazz Festival 1958–2007 (2008)
• Yo-Yo Ma & Friends Brubeck tracks: Joy to the World, Concordia. (2008)Sony BMG
• Everybody Wants To Be A Cat: Disney Jazz Volume 1 Brubeck tracks: Some Day My Prince Will Come, Alice In Wonderland (with Roberta Gambarini) (2011)
• Their Last Time Out (DBQ recorded Live, 12/26/67) (2011)

References[link]

Bibliography[link]

• Isenberg, Barbara. State of the Arts: California Artists Talk About Their Work. 2005

Others[link]

• Photographs, documents, and video clips of oral history interviews from the Brubeck Collection are available at the University of the Pacific Library's Digital Collections.

External links[link]

Wikimedia Commons has media related to: Dave Brubeck

• Official website