Congestive heart failure overview

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Congestive Heart Failure Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Systolic Dysfunction
Diastolic Dysfunction
HFpEF
HFrEF

Causes

Differentiating Congestive heart failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Clinical Assessment

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

Cardiac MRI

Echocardiography

Exercise Stress Test

Myocardial Viability Studies

Cardiac Catheterization

Other Imaging Studies

Other Diagnostic Studies

Treatment

Invasive Hemodynamic Monitoring

Medical Therapy:

Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
Diuretics
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Nitrates
Hydralazine
Positive Inotropics
Anticoagulants
Angiotensin Receptor-Neprilysin Inhibitor
Antiarrhythmic Drugs
Nutritional Supplements
Hormonal Therapies
Drugs to Avoid
Drug Interactions
Treatment of underlying causes
Associated conditions

Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Ultrafiltration
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

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
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

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

Congestive heart failure overview On the Web

Most recent articles

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Review articles

CME Programs

Powerpoint slides

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Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Congestive heart failure overview

CDC on Congestive heart failure overview

Congestive heart failure overview in the news

Blogs on Congestive heart failure overview

Directions to Hospitals Treating Congestive heart failure overview

Risk calculators and risk factors for Congestive heart failure overview

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

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Saleh El Dassouki, M.D [3], Atif Mohammad, MD

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Overview of Congestive Heart Failure

One of the multiple definitions of heart failure is any condition of the heart that results in the inability of the heart to meet the demands of the circulation. It is also defined as complex clinical syndrome due to the abnormalities of the cardiac structure and /or function that impairs the left ventricle to fill or eject blood.The classic syndrome of heart failure is dyspnea, fatigue, and fluid retention.


Heart failure could results from abnormality of any one or combination of the components of the heart; the pericardium, myocardium, endocardium or even from the abnormality of great vessels. Heart failure was once thought to be secondary to depressed left ventricular ejection fraction, however studies have shown that approximately 50% of the patients who have heart failure have normal ejection fraction. Patient may be broadly classified as having heart failure with depressed left ventricular ejection fraction (systolic dysfunction) or normal or preserved ejection fraction (diastolic dysfunction). It is also common to have both systolic and diastolic dysfunction together at the same time.


Patients with heart failure present in different ways. Some patients present with exercise intolerance with little evidence of congestion or edema, others present with edema and congestion with minimal symptoms. Congestive heart failure is a outdated term as it was noted in the past that majority of the patients with heart failure were edematous or fluid overloaded. With the current medical and device therapy most patients are euvolumic , hence the term “heart failure” is preferred over “congestive heart failure”.


Heart failure is not synonymous with cardiomyopathy or left ventricular dysfunction, the latter terms are used to describe structural or functional abnormality that could lead to heart failure.Heart failure is as clinical syndrome charecterized by specific symptoms(dysnea and fatigue) in the history and signs(rales) on physical examination. There is no single test to diagnose heart failure.It is largely a clinical diagnosis based on careful history and physical examination.

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