Congestive heart failure treatment of underlying causes: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
Line 10: Line 10:
|}
|}
{{Congestive heart failure}}
{{Congestive heart failure}}
{{CMG}}
{{CMG}}; {{AE}} {{EdzelCo}}


==Overview==
==Overview==
Treatment of the underlying cause of heart failure including [[ischemic heart disease]], [[hypertension]], renovascular disease, or [[valvular heart disease]] is critical in the management of the patient with congestive heart failure.
[[Treatment]] of the underlying [[cause]] of [[heart failure]] including [[ischemic heart disease]], [[hypertension]], [[renovascular disease]], or [[valvular heart disease]] is critical in the [[management]] of the [[patient]] with [[congestive heart failure]].


==Ischemic Heart Disease==
==[[Ischemic Heart Disease]]==
Underlying ischemic heart disease is the most common cause of chronic congestive heart failure and is the underlying cause of heart failure in 50% to 75% of patients<ref name="pmid7977122">{{cite journal |author=Bortman G, Sellanes M, Odell DS, Ring WS, Olivari MT |title=Discrepancy between pre- and post-transplant diagnosis of end-stage dilated cardiomyopathy |journal=[[The American Journal of Cardiology]] |volume=74 |issue=9 |pages=921–4 |year=1994 |month=November |pmid=7977122 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0002-9149(94)90587-8 |issn= |accessdate=2013-04-25}}</ref>.  Ischemic heart disease results in systolic dysfunction of the heart due to irreversible damage of the left ventricle if there has been a prior MI.  There can also be viable tissue that is stunned or hibernating as a cause of heart failure.  The management of these patients consists of risk factor modification (for example with the use of [[statins]] or [[beta blockers]] ) as well as the relief of angina (for example with the use of [[nitrates]] ).  Revascularization (percuataneous coronary intervention or coronary artery bypass grafting) is indicated in the following scenarios:
Underlying [[ischemic heart disease]] is the most common cause of [[chronic]] [[congestive heart failure]] and is the underlying cause of [[heart failure]] in 50% to 75% of [[patients]]. <ref name="pmid7977122">{{cite journal |author=Bortman G, Sellanes M, Odell DS, Ring WS, Olivari MT |title=Discrepancy between pre- and post-transplant diagnosis of end-stage dilated cardiomyopathy |journal=[[The American Journal of Cardiology]] |volume=74 |issue=9 |pages=921–4 |year=1994 |month=November |pmid=7977122 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0002-9149(94)90587-8 |issn= |accessdate=2013-04-25}}</ref>.  [[Ischemic heart disease]] results in [[systolic dysfunction]] of the [[heart]] due to [[irreversible damage]] of the [[left ventricle]] if there has been a prior [[MI]].  There can also be [[viable tissue]] that is stunned or hibernating as a cause of [[heart failure]].  The [[management]] of these [[patients]] consists of risk factor modification (for example with the use of [[statins]] or [[beta blockers]] ) as well as the relief of [[angina]] (for example with the use of [[nitrates]] ).  [[Revascularization]] ([[percuataneous coronary intervention]] or [[coronary artery bypass grafting]]) is indicated in the following scenarios:
*To improve symptoms.
*To improve [[symptoms]].
*To improve prognosis.  If there is a perfusion defect, revascularization may improve prognosis.  
*To improve [[prognosis]].  If there is a [[perfusion]] defect, [[revascularization]] may improve [[prognosis]].  
*To prevent recurrent [[heart failure]] decompensation.  If the patient has repeated episodes of [[congestive heart failure]] decompensation, revascularization may be indicated.
*To prevent recurrent [[heart failure]] [[decompensation]].  If the patient has repeated episodes of [[congestive heart failure]] [[decompensation]], [[revascularization]] may be indicated.


==2022 ACC/AHA/HFSA Heart Failure Guideline (DO NOT EDIT)==
==2022 ACC/AHA/HFSA Heart Failure Guideline (DO NOT EDIT)==

Revision as of 22:07, 22 June 2022
Resident
Survival
Guide
File:Critical Pathways.gif

Congestive Heart Failure Microchapters

Home

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 treatment of underlying causes On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Congestive heart failure treatment of underlying causes

CDC on Congestive heart failure treatment of underlying causes

Congestive heart failure treatment of underlying causes in the news

Blogs on Congestive heart failure treatment of underlying causes

Directions to Hospitals Treating Congestive heart failure treatment of underlying causes

Risk calculators and risk factors for Congestive heart failure treatment of underlying causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Edzel Lorraine Co, DMD, MD[2]

Overview

Treatment of the underlying cause of heart failure including ischemic heart disease, hypertension, renovascular disease, or valvular heart disease is critical in the management of the patient with congestive heart failure.

Ischemic Heart Disease

Underlying ischemic heart disease is the most common cause of chronic congestive heart failure and is the underlying cause of heart failure in 50% to 75% of patients. [1]. Ischemic heart disease results in systolic dysfunction of the heart due to irreversible damage of the left ventricle if there has been a prior MI. There can also be viable tissue that is stunned or hibernating as a cause of heart failure. The management of these patients consists of risk factor modification (for example with the use of statins or beta blockers ) as well as the relief of angina (for example with the use of nitrates ). Revascularization (percuataneous coronary intervention or coronary artery bypass grafting) is indicated in the following scenarios:

2022 ACC/AHA/HFSA Heart Failure Guideline (DO NOT EDIT)

Revascularization for CAD

Class I
"1. In selected patients with HF, reduced EF (EF ≤ 35%), and suitable coronary anatomy, surgical revascularization plus GDMT is beneficial to improve symptoms, cardiovascular hospitalizations, and long-term all-cause mortality. [2][3][4][5][6][7][8][9] (Level of Evidence: B-R) "

Hypertension

Hypertension is a common underlying cause of congestive heart failure. There are 2 goals in the treatment of the congestive heart failure patient with hypertension:

1. Reduce the preload and

2. Reduce the afterload

The following agents improve survival in the heart failure patient and are the preferred antihypertensive agents:

Patients with bilateral renal artery stenosis tend to have a greater risk of flash pulmonary edema than those patients with unilateral renal artery stenosis[10]. This combination of flash pulmonary edema and bilateral renal artery stenosis is known as Pickering syndrome[11]. Is not unreasonable for patients with recurrent flash pulmonary edema and renal artery stenosis to undergo revascularization. The data in support of this recommendation however is modest.

2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure

Class I

1. In patients at increased risk, stage A HF, the optimal blood pressure in those with hypertension should be less than 130/80 mm Hg. (Class I, Level of Evidence: B-R)

2. Patients with HFrEF and hypertension should be prescribed GDMT titrated to attain systolic blood pressure less than 130 mm Hg. (Class I, Level of Evidence: C-EO)

3. Patients with HFpEF and persistent hypertension after management of volume overload should be prescribed GDMT titrated to attain systolic blood pressure less than 130 mm Hg. (Class I, Level of Evidence: C-LD)

Class IIa

1. The use of beta-blocking agents, ACE inhibitors, and ARBs in patients with hypertension is reasonable to control blood pressure in patients with HFpEF. (Class IIa, Level of Evidence: C)

Valvular Heart Disease

In 10% to 12% of patients, valvular heart disease is the underlying cause of congestive heart failure[12]. It should also be noted that as the heart dilates in the setting of heart failure, there is often secondary mitral regurgitation and tricuspid regurgitation in many patients with a dilated cardiomyopathy. Please consult of the chapters on either mitral regurgitation or aortic regurgitation regarding the treatment of valvular heart disease. In general, once the left ventricular systolic diameter begins to increase, mitral valve repair ( left ventricular end systolic diameter greater than 45 mm) or aortic valve replacement (left ventricular end systolic diameter greater than 55 mm) is often indicated.

Other Underlying Disorders That May Warrant Treatment

There are a variety of other systemic or cardiovascular disorders that may secondarily cause heart failure, and these primary disorders may warrant treatment as well:

References

  1. ↑ Bortman G, Sellanes M, Odell DS, Ring WS, Olivari MT (1994). "Discrepancy between pre- and post-transplant diagnosis of end-stage dilated cardiomyopathy". The American Journal of Cardiology. 74 (9): 921–4. PMID 7977122. Retrieved 2013-04-25. Unknown parameter |month= ignored (help)
  2. ↑ Caracciolo EA, Davis KB, Sopko G, Kaiser GC, Corley SD, Schaff H; et al. (1995). "Comparison of surgical and medical group survival in patients with left main equivalent coronary artery disease. Long-term CASS experience". Circulation. 91 (9): 2335–44. doi:10.1161/01.cir.91.9.2335. PMID 7729019.
  3. ↑ Howlett JG, Stebbins A, Petrie MC, Jhund PS, Castelvecchio S, Cherniavsky A; et al. (2019). "CABG Improves Outcomes in Patients With Ischemic Cardiomyopathy: 10-Year Follow-Up of the STICH Trial". JACC Heart Fail. 7 (10): 878–887. doi:10.1016/j.jchf.2019.04.018. PMC 7375257 Check |pmc= value (help). PMID 31521682.
  4. ↑ Mark DB, Knight JD, Velazquez EJ, Wasilewski J, Howlett JG, Smith PK; et al. (2014). "Quality-of-life outcomes with coronary artery bypass graft surgery in ischemic left ventricular dysfunction: a randomized trial". Ann Intern Med. 161 (6): 392–9. doi:10.7326/M13-1380. PMC 4182862. PMID 25222386.
  5. ↑ Park S, Ahn JM, Kim TO, Park H, Kang DY, Lee PH; et al. (2020). "Revascularization in Patients With Left Main Coronary Artery Disease and Left Ventricular Dysfunction". J Am Coll Cardiol. 76 (12): 1395–1406. doi:10.1016/j.jacc.2020.07.047. PMID 32943156 Check |pmid= value (help).
  6. ↑ Petrie MC, Jhund PS, She L, Adlbrecht C, Doenst T, Panza JA; et al. (2016). "Ten-Year Outcomes After Coronary Artery Bypass Grafting According to Age in Patients With Heart Failure and Left Ventricular Systolic Dysfunction: An Analysis of the Extended Follow-Up of the STICH Trial (Surgical Treatment for Ischemic Heart Failure)". Circulation. 134 (18): 1314–1324. doi:10.1161/CIRCULATIONAHA.116.024800. PMC 5089908. PMID 27573034.
  7. ↑ Tam DY, Dharma C, Rocha R, Farkouh ME, Abdel-Qadir H, Sun LY; et al. (2020). "Long-Term Survival After Surgical or Percutaneous Revascularization in Patients With Diabetes and Multivessel Coronary Disease". J Am Coll Cardiol. 76 (10): 1153–1164. doi:10.1016/j.jacc.2020.06.052. PMC 7861124 Check |pmc= value (help). PMID 32883408 Check |pmid= value (help).
  8. ↑ Velazquez EJ, Lee KL, Deja MA, Jain A, Sopko G, Marchenko A; et al. (2011). "Coronary-artery bypass surgery in patients with left ventricular dysfunction". N Engl J Med. 364 (17): 1607–16. doi:10.1056/NEJMoa1100356. PMC 3415273. PMID 21463150. Review in: Ann Intern Med. 2011 Aug 16;155(4):JC2-9 Review in: Evid Based Med. 2012 Dec;17(6):178-9
  9. ↑ Velazquez EJ, Lee KL, Jones RH, Al-Khalidi HR, Hill JA, Panza JA; et al. (2016). "Coronary-Artery Bypass Surgery in Patients with Ischemic Cardiomyopathy". N Engl J Med. 374 (16): 1511–20. doi:10.1056/NEJMoa1602001. PMC 4938005. PMID 27040723. Review in: Ann Intern Med. 2016 Aug 16;165(4):JC15 Review in: Evid Based Med. 2017 Mar;22(1):32
  10. ↑ Pickering TG, Herman L, Devereux RB, Sotelo JE, James GD, Sos TA, Silane MF, Laragh JH (1988). "Recurrent pulmonary oedema in hypertension due to bilateral renal artery stenosis: treatment by angioplasty or surgical revascularisation". Lancet. 2 (8610): 551–2. PMID 2900930. Unknown parameter |month= ignored (help); Check date values in: |accessdate= (help); |access-date= requires |url= (help)
  11. ↑ Messerli FH, Bangalore S, Makani H, Rimoldi SF, Allemann Y, White CJ, Textor S, Sleight P (2011). "Flash pulmonary oedema and bilateral renal artery stenosis: the Pickering syndrome". European Heart Journal. 32 (18): 2231–5. doi:10.1093/eurheartj/ehr056. PMID 21406441. Retrieved 2013-04-25. Unknown parameter |month= ignored (help)
  12. ↑ Jessup M, Brozena S (2003). "Heart failure". The New England Journal of Medicine. 348 (20): 2007–18. doi:10.1056/NEJMra021498. PMID 12748317. Retrieved 2013-04-25. Unknown parameter |month= ignored (help)

Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Congestive_heart_failure_treatment_of_underlying_causes&oldid=1726664"