Congestive heart failure clinical assessment: Difference between revisions

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{{Congestive heart failure}}


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==Overview of Clinical Assessment of Congestive Heart Failure==
==Overview of Clinical Assessment of Congestive Heart Failure==


==ACC / AHA Guidelines- Initial Clinical Assessment of Patients Presenting With HF (DO NOT EDIT) <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref>==
==ACC/AHA Guidelines- Initial Clinical Assessment of Patients Presenting With Heart Failure (DO NOT EDIT) <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>==
{{cquote|   
{{cquote|   
===Class I===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]===
1. A thorough history and physical examination should be obtained/performed in patients presenting with [[HF]] to identify cardiac and noncardiac disorders or behaviors that might cause or accelerate the development or progression of [[HF]]. ''(Level of Evidence: C)''
'''1.''' A thorough history and physical examination should be obtained/performed in patients presenting with [[HF]] to identify cardiac and noncardiac disorders or behaviors that might cause or accelerate the development or progression of [[HF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


2. A careful history of current and past use of [[alcohol]], illicit drugs, current or past standard or “alternative therapies,” and [[chemotherapy]] drugs should be obtained from patients presenting with [[HF]]. ''(Level of Evidence: C)''
'''2.''' A careful history of current and past use of [[alcohol]], illicit drugs, current or past standard or “alternative therapies,” and [[chemotherapy]] drugs should be obtained from patients presenting with [[HF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


3. In patients presenting with [[HF]], initial assessment should be made of the patient’s ability to perform routine and desired activities of daily living. ''(Level of Evidence: C)''
'''3.''' In patients presenting with [[HF]], initial assessment should be made of the patient’s ability to perform routine and desired activities of daily living. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


4. Initial examination of patients presenting with [[HF]] should include assessment of the patient’s volume status, orthostatic [[blood pressure]] changes, measurement of weight and height, and calculation of [[body mass index]]. ''(Level of Evidence: C)''
'''4.''' Initial examination of patients presenting with [[HF]] should include assessment of the patient’s volume status, orthostatic [[blood pressure]] changes, measurement of weight and height, and calculation of [[body mass index]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


5. Initial laboratory evaluation of patients presenting with [[HF]] should include complete blood count, urinalysis, serum electrolytes (including [[calcium]] and [[magnesium]]), [[blood urea nitrogen]], [[serum creatinine]], fasting blood glucose ([[glycohemoglobin]]), [[lipid]] profile, [[liver]] function tests, and [[thyroid-stimulating hormone]]. ''(Level of Evidence: C)''
'''5.''' Initial laboratory evaluation of patients presenting with [[HF]] should include complete blood count, urinalysis, serum electrolytes (including [[calcium]] and [[magnesium]]), [[blood urea nitrogen]], [[serum creatinine]], fasting blood glucose ([[glycohemoglobin]]), [[lipid]] profile, [[liver]] function tests, and [[thyroid-stimulating hormone]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


6. [[Twelve-lead electrocardiogram]] and [[chest radiograph]] (PA and lateral) should be performed initially in all patients presenting with [[HF]]. ''(Level of Evidence: C)''
'''6.''' [[Twelve-lead electrocardiogram]] and [[chest radiograph]] (PA and lateral) should be performed initially in all patients presenting with [[HF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


7. Two-dimensional [[echocardiography]] with Doppler should be performed during initial evaluation of patients presenting with [[HF]] to assess [[LVEF]], LV size, wall thickness, and valve function. Radionuclide [[ventriculography]] can be performed to assess [[LVEF]] and volumes. ''(Level of Evidence: C)''
'''7.''' Two-dimensional [[echocardiography]] with Doppler should be performed during initial evaluation of patients presenting with [[HF]] to assess [[LVEF]], LV size, wall thickness, and valve function. Radionuclide [[ventriculography]] can be performed to assess [[LVEF]] and volumes. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


8. [[Coronary arteriography]] should be performed in patients presenting with [[HF]] who have [[angina]] or significant [[ischemia]] unless the patient is not eligible for [[revascularization]] of any kind. ''(Level of Evidence: B)''
'''8.''' [[Coronary arteriography]] should be performed in patients presenting with [[HF]] who have [[angina]] or significant [[ischemia]] unless the patient is not eligible for [[revascularization]] of any kind. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''


===Class IIa===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]===
1. [[Coronary arteriography]] is reasonable for patients presenting with [[HF]] who have [[chest pain]] that may or may not be of cardiac origin who have not had evaluation of their coronary anatomy and who have no contraindications to [[coronary revascularization]]. ''(Level of Evidence: C)''
'''1.''' [[Coronary arteriography]] is reasonable for patients presenting with [[HF]] who have [[chest pain]] that may or may not be of cardiac origin who have not had evaluation of their coronary anatomy and who have no contraindications to [[coronary revascularization]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


2. [[Coronary arteriography]] is reasonable for patients presenting with [[HF]] who have known or suspected [[coronary artery disease]] but who do not have [[angina]] unless the patient is not eligible for [[revascularization]] of any kind. ''(Level of Evidence: C)''
'''2.''' [[Coronary arteriography]] is reasonable for patients presenting with [[HF]] who have known or suspected [[coronary artery disease]] but who do not have [[angina]] unless the patient is not eligible for [[revascularization]] of any kind. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


3. Noninvasive imaging to detect [[myocardial ischemia]] and viability is reasonable in patients presenting with [[HF]] who have known [[coronary artery disease]] and no [[angina]] unless the patient is not eligible for [[revascularization]] of any kind. ''(Level of Evidence: B)''
'''3.''' Noninvasive imaging to detect [[myocardial ischemia]] and viability is reasonable in patients presenting with [[HF]] who have known [[coronary artery disease]] and no [[angina]] unless the patient is not eligible for [[revascularization]] of any kind. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''


4. Maximal [[exercise test]]ing with or without measurement of [[respiratory gas exchange]] and/or [[blood oxygen saturation]] is reasonable in patients presenting with [[HF]] to help determine whether [[HF]] is the cause of exercise limitation when the contribution of [[HF]] is uncertain. ''(Level of Evidence: C)''
'''4.''' Maximal [[exercise test]]ing with or without measurement of [[respiratory gas exchange]] and/or [[blood oxygen saturation]] is reasonable in patients presenting with [[HF]] to help determine whether [[HF]] is the cause of exercise limitation when the contribution of [[HF]] is uncertain. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


5. Maximal [[exercise test]]ing with measurement of [[respiratory gas exchange]] is reasonable to identify high-risk patients presenting with [[HF]] who are candidates for [[cardiac transplantation]] or other advanced treatments. ''(Level of Evidence: B)''
'''5.''' Maximal [[exercise test]]ing with measurement of [[respiratory gas exchange]] is reasonable to identify high-risk patients presenting with [[HF]] who are candidates for [[cardiac transplantation]] or other advanced treatments. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''


6. Screening for [[hemochromatosis]], sleep-disturbed breathing, or [[human immunodeficiency virus]] is reasonable in selected patients who present with [[HF]]. ''(Level of Evidence: C)''
'''6.''' Screening for [[hemochromatosis]], sleep-disturbed breathing, or [[human immunodeficiency virus]] is reasonable in selected patients who present with [[HF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


7. Diagnostic tests for [[rheumatologic disease]]s, [[amyloidosis]], or [[pheochromocytoma]] are reasonable in patients presenting with [[HF]] in whom there is a clinical suspicion of these diseases. ''(Level of Evidence: C)''
'''7.''' Diagnostic tests for [[rheumatologic disease]]s, [[amyloidosis]], or [[pheochromocytoma]] are reasonable in patients presenting with [[HF]] in whom there is a clinical suspicion of these diseases. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


8. Endomyocardial biopsy can be useful in patients presenting with [[HF]] when a specific diagnosis is suspected that would influence therapy. ''(Level of Evidence: C)''
'''8.''' Endomyocardial biopsy can be useful in patients presenting with [[HF]] when a specific diagnosis is suspected that would influence therapy. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


9. Measurement of [[B-type natriuretic peptide]] ([[BNP]]) can be useful in the evaluation of patients presenting in the urgent care setting in whom the clinical diagnosis of [[HF]] is uncertain. ''(Level of Evidence: A)''
'''9.''' Measurement of [[B-type natriuretic peptide]] ([[BNP]]) can be useful in the evaluation of patients presenting in the urgent care setting in whom the clinical diagnosis of [[HF]] is uncertain. Measurement of [[B-type natriuretic peptide|natriuretic peptides]] ([[BNP]] and NT-proBNP) can be useful in risk stratification''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''


===Class IIb===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]===
1. Noninvasive imaging may be considered to define the likelihood of [[coronary artery disease]] in patients with [[HF]] and [[LV dysfunction]]. ''(Level of Evidence: C)''
'''1.''' Noninvasive imaging may be considered to define the likelihood of [[coronary artery disease]] in patients with [[HF]] and [[LV dysfunction]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


2. [[Holter monitoring]] might be considered in patients presenting with [[HF]] who have a history of [[MI]] and are being considered for electrophysiologic study to document [[VT]] inducibility. ''(Level of Evidence: C)''
'''2.''' [[Holter monitoring]] might be considered in patients presenting with [[HF]] who have a history of [[MI]] and are being considered for electrophysiologic study to document [[VT]] inducibility. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


===Class III===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]===
1. Endomyocardial biopsy should not be performed in the routine evaluation of patients with [[HF]]. ''(Level of Evidence: C)''
'''1.''' Endomyocardial biopsy should not be performed in the routine evaluation of patients with [[HF]].<ref name="pmid17959655">Cooper LT, Baughman KL, Feldman AM, Frustaci A, Jessup M, Kuhl U et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17959655 The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology.] ''Circulation'' 116 (19):2216-33. [http://dx.doi.org/10.1161/CIRCULATIONAHA.107.186093 DOI:10.1161/CIRCULATIONAHA.107.186093] PMID: [http://pubmed.gov/17959655 17959655]</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


2. Routine use of signal-averaged [[electrocardiography]] is not recommended for the evaluation of patients presenting with [[HF]]. ''(Level of Evidence: C)''
'''2.''' Routine use of signal-averaged [[electrocardiography]] is not recommended for the evaluation of patients presenting with [[HF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


3. Routine measurement of circulating levels of neurohormones (e.g., [[norepinephrine]] or [[endothelin]]) is not recommended for patients presenting with [[HF]]. ''(Level of Evidence: C)''}}
'''3.''' Routine measurement of circulating levels of neurohormones (e.g., [[norepinephrine]] or [[endothelin]]) is not recommended for patients presenting with [[HF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}


==ACC / AHA Guidelines- Serial Clinical Assessment of Patients Presenting With HF (DO NOT EDIT) <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref>==
==ACC / AHA Guidelines- Serial Clinical Assessment of Patients Presenting With HF (DO NOT EDIT) <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref>==
Line 87: Line 84:
1. The value of serial measurements of [[BNP]] to guide therapy for patients with [[HF]] is not well established. ''(Level of Evidence: C)''}}
1. The value of serial measurements of [[BNP]] to guide therapy for patients with [[HF]] is not well established. ''(Level of Evidence: C)''}}


==See Also==
==Vote on and Suggest Revisions to the Current Guidelines==
* [[The Living Guidelines: Diagnosis and Management of Chronic Heart Failure | The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
*[[The Living Guidelines: Diagnosis and Management of Chronic Heart Failure | The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]


==Sources==
==Guidelines Resources==
* The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref>
*[http://circ.ahajournals.org/content/112/12/e154.full.pdf The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult]<ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref>
 
*[http://content.onlinejacc.org/cgi/reprint/53/15/1343.pdf 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation]<ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


{{SIB}}
[[Category:Disease]]
 
[[Category:DiseaseState]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]

Revision as of 01:35, 2 November 2011

Heart failure
ICD-10 I50.0
ICD-9 428.0
DiseasesDB 16209
MedlinePlus 000158
MeSH D006333
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
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Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Nitrates
Hydralazine
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Angiotensin Receptor-Neprilysin Inhibitor
Antiarrhythmic Drugs
Nutritional Supplements
Hormonal Therapies
Drugs to Avoid
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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 clinical assessment On the Web

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US National Guidelines Clearinghouse

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Directions to Hospitals Treating Congestive heart failure clinical assessment

Risk calculators and risk factors for Congestive heart failure clinical assessment

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

Overview of Clinical Assessment of Congestive Heart Failure

ACC/AHA Guidelines- Initial Clinical Assessment of Patients Presenting With Heart Failure (DO NOT EDIT) [1][2]

“

Class I

1. A thorough history and physical examination should be obtained/performed in patients presenting with HF to identify cardiac and noncardiac disorders or behaviors that might cause or accelerate the development or progression of HF. (Level of Evidence: C)

2. A careful history of current and past use of alcohol, illicit drugs, current or past standard or “alternative therapies,” and chemotherapy drugs should be obtained from patients presenting with HF. (Level of Evidence: C)

3. In patients presenting with HF, initial assessment should be made of the patient’s ability to perform routine and desired activities of daily living. (Level of Evidence: C)

4. Initial examination of patients presenting with HF should include assessment of the patient’s volume status, orthostatic blood pressure changes, measurement of weight and height, and calculation of body mass index. (Level of Evidence: C)

5. Initial laboratory evaluation of patients presenting with HF should include complete blood count, urinalysis, serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, fasting blood glucose (glycohemoglobin), lipid profile, liver function tests, and thyroid-stimulating hormone. (Level of Evidence: C)

6. Twelve-lead electrocardiogram and chest radiograph (PA and lateral) should be performed initially in all patients presenting with HF. (Level of Evidence: C)

7. Two-dimensional echocardiography with Doppler should be performed during initial evaluation of patients presenting with HF to assess LVEF, LV size, wall thickness, and valve function. Radionuclide ventriculography can be performed to assess LVEF and volumes. (Level of Evidence: C)

8. Coronary arteriography should be performed in patients presenting with HF who have angina or significant ischemia unless the patient is not eligible for revascularization of any kind. (Level of Evidence: B)

Class IIa

1. Coronary arteriography is reasonable for patients presenting with HF who have chest pain that may or may not be of cardiac origin who have not had evaluation of their coronary anatomy and who have no contraindications to coronary revascularization. (Level of Evidence: C)

2. Coronary arteriography is reasonable for patients presenting with HF who have known or suspected coronary artery disease but who do not have angina unless the patient is not eligible for revascularization of any kind. (Level of Evidence: C)

3. Noninvasive imaging to detect myocardial ischemia and viability is reasonable in patients presenting with HF who have known coronary artery disease and no angina unless the patient is not eligible for revascularization of any kind. (Level of Evidence: B)

4. Maximal exercise testing with or without measurement of respiratory gas exchange and/or blood oxygen saturation is reasonable in patients presenting with HF to help determine whether HF is the cause of exercise limitation when the contribution of HF is uncertain. (Level of Evidence: C)

5. Maximal exercise testing with measurement of respiratory gas exchange is reasonable to identify high-risk patients presenting with HF who are candidates for cardiac transplantation or other advanced treatments. (Level of Evidence: B)

6. Screening for hemochromatosis, sleep-disturbed breathing, or human immunodeficiency virus is reasonable in selected patients who present with HF. (Level of Evidence: C)

7. Diagnostic tests for rheumatologic diseases, amyloidosis, or pheochromocytoma are reasonable in patients presenting with HF in whom there is a clinical suspicion of these diseases. (Level of Evidence: C)

8. Endomyocardial biopsy can be useful in patients presenting with HF when a specific diagnosis is suspected that would influence therapy. (Level of Evidence: C)

9. Measurement of B-type natriuretic peptide (BNP) can be useful in the evaluation of patients presenting in the urgent care setting in whom the clinical diagnosis of HF is uncertain. Measurement of natriuretic peptides (BNP and NT-proBNP) can be useful in risk stratification(Level of Evidence: A)

Class IIb

1. Noninvasive imaging may be considered to define the likelihood of coronary artery disease in patients with HF and LV dysfunction. (Level of Evidence: C)

2. Holter monitoring might be considered in patients presenting with HF who have a history of MI and are being considered for electrophysiologic study to document VT inducibility. (Level of Evidence: C)

Class III

1. Endomyocardial biopsy should not be performed in the routine evaluation of patients with HF.[3] (Level of Evidence: C)

2. Routine use of signal-averaged electrocardiography is not recommended for the evaluation of patients presenting with HF. (Level of Evidence: C)

3. Routine measurement of circulating levels of neurohormones (e.g., norepinephrine or endothelin) is not recommended for patients presenting with HF. (Level of Evidence: C)

”

ACC / AHA Guidelines- Serial Clinical Assessment of Patients Presenting With HF (DO NOT EDIT) [1]

“

Class I

1. Assessment should be made at each visit of the ability of a patient with HF to perform routine and desired activities of daily living. (Level of Evidence: C)

2. Assessment should be made at each visit of the volume status and weight of a patient with HF. (Level of Evidence: C)

3. Careful history of current use of alcohol, tobacco, illicit drugs, “alternative therapies,” and chemotherapy drugs, as well as diet and sodium intake, should be obtained at each visit of a patient with HF. (Level of Evidence: C)

Class IIa

1. Repeat measurement of EF and the severity of structural remodeling can provide useful information in patients with HF who have had a change in clinical status or who have experienced or recovered from a clinical event or received treatment that might have had a significant effect on cardiac function. (Level of Evidence: C)

Class IIb

1. The value of serial measurements of BNP to guide therapy for patients with HF is not well established. (Level of Evidence: C)

”

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Guidelines Resources

References

  1. ↑ 1.0 1.1 1.2 Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202
  2. ↑ 2.0 2.1 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967
  3. ↑ Cooper LT, Baughman KL, Feldman AM, Frustaci A, Jessup M, Kuhl U et al. (2007) The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Circulation 116 (19):2216-33. DOI:10.1161/CIRCULATIONAHA.107.186093 PMID: 17959655


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