Congestive heart failure cardiac catheterization

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Summary
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Chronic Pharmacotherapy in HFrEF
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Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
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ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
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Congestive heart failure end-of-life considerations

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Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Cardiac Catheterization

Coronary Angiography

Coronary angiography is perfomred in patients with heart failure in whom there is a suspicion of underlying atherosclerosis as the basis for the heart failure. Patients who are troponin or CK-MB positive, who have dynamic EKG changes or other signs and symptoms of an acute coronary syndrome who are revascularization candidates should undergo coronary angiography.

Hemodynamic Assessment

Right Heart Catheterization

Right heart catheterization can be useful to assess the following:

Left Heart Catheterization

Left heart catheterization can be useful to assess the following:


Class I
"Invasive coronary angiography is recommended in patients with angina despite medical therapy or symptomatic ventricular arrhythmias.(Level of Evidence: B) "
Class IIb
" Invasive coronary angiography may be considered in patients with HFrEF with an intermediate to high pre-test probability of CAD and the presence of ischemia in non-invasive stress tests.(Level of Evidence: B) "
Class I
" Right heart catheterization is recommended in patients with severe HF being evaluated for heart transplantation or mechanical circulatory support (Level of Evidence: C) "
Class IIa
" Right heart catheterization is reasonable in HF patients with suspicion of constrictive pericarditis, restrictive cardiomyopathy, congenital heart disease, and high output states.(Level of Evidence: C) "
Class IIb
" Right heart catheterization may be considered in selected patients with HFpEF to confirm the diagnosis..(Level of Evidence: C) "
The above table adopted from 2021 ESC Guideline

[1]

References

  1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland J, Coats A, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam C, Lyon AR, McMurray J, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano G, Ruschitzka F, Kathrine Skibelund A (September 2021). "2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure". Eur Heart J. 42 (36): 3599–3726. doi:10.1093/eurheartj/ehab368. PMID 34447992 Check |pmid= value (help). Vancouver style error: initials (help)

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