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| __NOTOC__
| | #Redirect [[Heart failure resident survival guide]] |
| {{CMG}}; {{AE}} {{MS}}; {{AO}}
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| ==Overview==
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| ==Prevention==
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| {{familytree/start}}
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| {{familytree | | | | | A00 | | A00=<div style="float: left; text-align: left; width: 25em; padding:1em;">'''Does the patient have stage A or stage B of heart failure according to the [[Acute heart failure resident survival guide#Classification|ACCF/AHA staging system]]?'''</div>}}
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| {{familytree | |,|-|-|-|+|-|-|-|.| | | | }}
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| {{familytree | Z01 | | Z02 | | Z03 | |Z01=<div style="float: left; text-align: left; width: 15em; padding:1em;">'''[[Acute heart failure resident survival guide#Prevention of Heart Failure|Stage A]]''' <br> <br>
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| ❑ '''At high risk for heart failure''' <br>
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| :❑ Patients with [[HTN]], [[DM]], [[obesity]], [[CAD]], [[metabolic syndrome]]<br>
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| :❑ Family history of [[cardiomyopathy]]<br>
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| :❑ Patients using cardiotoxins
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| <br> '''AND'''<br>
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| ❑ '''No structural heart disease'''
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| <br> '''AND'''<br>
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| ❑ '''No symptom of heart failure'''<br></div>|Z02=<div style="float: left; text-align: left; width: 15em; padding:1em;">'''[[Acute heart failure resident survival guide#Prevention of Heart Failure|Stage B]]''' <br> <br>
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| ❑ '''Patients with structural heart disease'''<br>
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| This refers to patients with the following:<br>
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| :❑ Previous [[MI]]<br>
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| :❑ LV remodeling* (including [[ LVH]] + low [[EF]])<br>
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| :❑ Asymptomatic [[valvular disease]]<br><br>'''AND'''<br>
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| ❑ '''No signs or symptoms of heart failure'''<br><br>
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| ''LV remodeling refers to the changes in size, shape and function of the heart resulting from cardiac load or injury''</div>|Z03=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Neither stage A nor stage B'''</div>}}
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| {{familytree | |!| | | |!| | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
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| {{familytree | A01 | | A02 | | A03 | |A01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Yes, the patient has stage A'''
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| ----
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| Therapeutic goals:<br>
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| ❑ Promote healthy lifestyle<br>
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| ❑ Prevent CAD and comorbidities<br>
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| ❑ Prevent LV structural abnormalities</div>|A02=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Yes, the patient has stage B'''
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| ----
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| Therapeutic goal:
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| ❑ Prevent symptoms of heart failure</div>
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| |A03=<div style="float: left; text-align: left; width: 20em; padding:1em;">No preventive therapy is needed</div>
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| }}
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| {{familytree | |!| | | |!| |}}
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| {{familytree | B01 | | B02 | | |B01=<div style="float: left; text-align: left; width: 20em; padding:1em;">
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| ❑ Control HTN and lipid disorders<br>
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| :❑ [[ACE inhibitors]] or ([[ARBs]]) in patients with vascular disease or DM<br>
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| :❑ [[Statins]]<br>
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| ❑ Minimize risk factors
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| :❑ Dietary sodium restriction (2-3 g daily)<br>
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| :❑ [[Smoking cessation]]<br>
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| :❑ Alcohol abstinence (≤2 standard drinks per day for men; ≤1 for women)<br>
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| :❑ Encourage exercise/physical activity</div>|B02=<div style="float: left; text-align: left; width: 20em; padding:1em;">
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| ❑ Administer [[ACE inhibitors]] or ([[ARBs]]) in patients with:<br>
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| :❑ Prior [[MI]] and LVEF ≤40% to prevent heart failure ([[ACC AHA guidelines classification scheme|Class I, level of evidence A]])<br>'''OR'''
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| :❑ LVEF ≤40% ([[ACC AHA guidelines classification scheme|Class I, level of evidence A]])<br>
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| ❑ Administer [[beta blockers]] in patients with:<br>
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| :❑ Prior [[MI]] and LVEF ≤ 40% to prevent heart failure ([[ACC AHA guidelines classification scheme|Class I, level of evidence B]])<br>
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| :❑ LVEF ≤ 40% to prevent heart failure ([[ACC AHA guidelines classification scheme|Class I, level of evidence C]])<br>
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| ❑ [[Statins]]<br>
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| :❑ Patients with MI ([[ACC AHA guidelines classification scheme|Class I, level of evidence A]])<br>
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| ❑ Implantable cardioverter defibrillator (ICD) to prevent sudden death in: <br>
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| :❑ Asymptomatic ischemic cardiomyopathy ([[ACC AHA guidelines classification scheme|Class IIa, level of evidence B]])<br>
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| ::❑ ≥ 40 day post-[[MI]]<br>
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| ::❑ LVEF ≤ 30%<br>
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| ::❑ On GDMT<br>
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| ❑<span style="font-size:100%;color:red"> The use of CCBs e.g., verapamil and diltiazem in patients with LVEF ≤ 30%</span></div>}}
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| {{familytree/end}}
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| ==References==
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| {{Reflist|2}}
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| [[Category:Disease]]
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| [[Category:Emergency medicine]]
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| [[Category:Medicine]]
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| [[Category:Primary care]]
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| [[Category:Resident survival guide]]
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| [[Category:Cardiology]]
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| [[Category:Up-To-Date]]
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| [[Category:Up-To-Date cardiology]]
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| [[Category:Intensive care medicine]]
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