Cardiology overview heart failure: Difference between revisions

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==Pathophysiology==
===Systolic Dysfunction===


===Diastolic dysfunction===
* The predictors of diastolic dysfunction include older age female gender and impaired kidney function.
==Pharmacotherapy==
==Pharmacotherapy==
===Angiotensin Converting Enzyme (ACE) Inhibition===
* Improve LV remodeling following ST elevation MI
* Even in patients who are asymptomatic with LV dysfunction, this class improves the odds of developing symptoms and survival.


===Lasix===
*Higher lasix doses are associated with higher mortality, likely as a surrogate of disease severity rather than part of a causal pathway.


===Beta Blockers===
==ACC / AHA Guidelines - Recommendations for Cardiac Resynchronization Therapy in Patients with Severe Systolic Heart Failure (DO NOT EDIT)<ref name="pmid18483207">{{cite journal |author=Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW |title=ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons |journal=[[Circulation]] |volume=117 |issue=21 |pages=e350–408 |year=2008 |month=May |pmid=18483207 |doi=10.1161/CIRCUALTIONAHA.108.189742 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18483207 |issn= |accessdate=2011-01-15}}</ref>==
Lopressor should be used instead of atenolol in the patient with CHF
{{cquote|


===Metformin===
==='''[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]'''===
*[[Metformin]] use in [[diabetics]] with [[CHF]] is associated with lower mortality


===Enoxaparin and Antiocagulation===
'''1)'''  For patients who have LVEF less than or equal to 35%, a QRS duration greater than or equal to 0.12 seconds, and sinus rhythm, CRT with or without an ICD is indicated for the treatment of NYHA functional Class III or ambulatory Class IV heart failure symptoms with optimal recommended medical therapy. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])
* While hospitalized, patients with CHF should receive [[DVT prophylaxis]]


===Drugs to Avoid in CHF===
==='''[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]'''===
* [[Dronedarone]] should be avoided in patients who were hospitalized with CHF (this is a boxed warning)
* [[Sotalol]] (has a negative inotropic effect)


'''1)''' For patients who have LVEF less than or equal to 35%, a QRS duration greater than or equal to 0.12 seconds, and AF, CRT with or without an ICD is reasonable for the treatment of NYHA functional Class III or ambulatory Class IV heart failure symptoms on optimal recommended medical therapy. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])


==Mechanical Therapy==
'''2)''' For patients with LVEF less than or equal to 35% with NYHA functional Class III or ambulatory Class IV symptoms who are receiving optimal recommended medical therapy and who have frequent dependence on ventricular pacing, CRT is reasonable. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])
* Cardiac resynchronization therapy has been associated with improvement in symptoms and a reduction in hospitalizations.


==Ultrafiltration==
==='''[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]'''===
* [[Ultrafiltration]] has been associated with a reduced incidence of hospitalization compared with diuretics in the UNLOAD trial. There was no difference in mortality.


==Invasive Monitoring==
'''1)''' For patients with LVEF less than or equal to 35% with NYHA functional Class I or II symptoms who are receiving optimal recommended medical therapy and who are undergoing implantation of a permanent pacemaker and/or ICD with anticipated frequent ventricular pacing, CRT may be considered. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])
* Based upon the results of the ESCAPE trial, there is no benefit in clinical outcomes with the use of a pulmonary artery line in patients with decompensated CHF.
 
==Obstructive Sleep Apnea in the Patient with CHF==
*[[Central sleep apnea]] in the patient with CHF is due to the compensatory [[respiratory alkalosis]] that is present in the patient with CHF and [[tachypnea]]


==References==
==References==

Latest revision as of 01:05, 4 November 2011

Cardiology Overview

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Pharmacology

Pregnancy

Preoperative evaluation

Prevention

Pulmonary hypertension

Stable angina

Valvular heart disease

Venous thromboembolism

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Pathophysiology

Systolic Dysfunction

Diastolic dysfunction

  • The predictors of diastolic dysfunction include older age female gender and impaired kidney function.

Pharmacotherapy

ACC / AHA Guidelines - Recommendations for Cardiac Resynchronization Therapy in Patients with Severe Systolic Heart Failure (DO NOT EDIT)[1]

{{cquote|

Class I

1) For patients who have LVEF less than or equal to 35%, a QRS duration greater than or equal to 0.12 seconds, and sinus rhythm, CRT with or without an ICD is indicated for the treatment of NYHA functional Class III or ambulatory Class IV heart failure symptoms with optimal recommended medical therapy. (Level of Evidence: A)

Class IIa

1) For patients who have LVEF less than or equal to 35%, a QRS duration greater than or equal to 0.12 seconds, and AF, CRT with or without an ICD is reasonable for the treatment of NYHA functional Class III or ambulatory Class IV heart failure symptoms on optimal recommended medical therapy. (Level of Evidence: B)

2) For patients with LVEF less than or equal to 35% with NYHA functional Class III or ambulatory Class IV symptoms who are receiving optimal recommended medical therapy and who have frequent dependence on ventricular pacing, CRT is reasonable. (Level of Evidence: C)

Class IIb

1) For patients with LVEF less than or equal to 35% with NYHA functional Class I or II symptoms who are receiving optimal recommended medical therapy and who are undergoing implantation of a permanent pacemaker and/or ICD with anticipated frequent ventricular pacing, CRT may be considered. (Level of Evidence: C)

References

  1. Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW (2008). "ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons". Circulation. 117 (21): e350–408. doi:10.1161/CIRCUALTIONAHA.108.189742. PMID 18483207. Retrieved 2011-01-15. Unknown parameter |month= ignored (help)

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