Congestive heart failure causes: Difference between revisions

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There are several general causes of heart failure. Heart failure may be of pericardial origin such as [[tamponade]] and [[pericardial constriction]], of valvular origin such as aortic or [[mitral regurgitation]]; of myocardial origin such as [[idiopathic dilated cardiomyopathy]], [[familial dilated cardiomyopathy]], [[ischemic cardiomyopathy]], [[valvular heart disease]]; or of coronary vascular origin such as acute ischemic episodes, and rhythm disturbances such as [[tachycardia-induced heart failure]].
There are several general causes of heart failure. Heart failure may be of pericardial origin such as [[tamponade]] and [[pericardial constriction]], of valvular origin such as aortic or [[mitral regurgitation]]; of myocardial origin such as [[idiopathic dilated cardiomyopathy]], [[familial dilated cardiomyopathy]], [[ischemic cardiomyopathy]], [[valvular heart disease]]; or of coronary vascular origin such as acute ischemic episodes, and rhythm disturbances such as [[tachycardia-induced heart failure]].
Other common secondary causes include [[anemia]], [[obesity]],[[drugs]] [(such as first generation [[calcium channel blockers]], [[disopyramide]], and [[sotalol]], [[NSAIDs]] (may cause [[fluid retention]]), [[beta blockers]] (may cause heart failure with their negative inotropic effects)].
Other common secondary causes include [[anemia]], [[obesity]],[[drugs]] [(such as first generation [[calcium channel blockers]], [[disopyramide]], and [[sotalol]], [[NSAIDs]] (may cause [[fluid retention]]), [[beta blockers]] (may cause heart failure with their negative inotropic effects)].
==Causes of Acute or Decompensated Heart Failure==
Chronic stable heart failure may easily decompensate. This most commonly results from an intercurrent illness (such as [[pneumonia]]), [[myocardial infarction]] (a heart attack), [[cardiac arrhythmia|arrhythmias]], uncontrolled [[hypertension]], or a patient's failure to maintain a fluid restriction, diet, or medication.<ref name="OPTIMIZE-HF">{{cite journal |author=Fonarow GC, Abraham WT, Albert NM, ''et al.'' |title=Factors Identified as Precipitating Hospital Admissions for Heart Failure and Clinical Outcomes: Findings From OPTIMIZE-HF |journal=Arch. Intern. Med. |volume=168 |issue=8 |pages=847–854 |year=2008 |month=April |pmid=18443260 |doi=10.1001/archinte.168.8.847}}</ref> Other well recognized precipitating factors include [[anemia]] and [[hyperthyroidism]] which place additional strain on the heart muscle. Excessive fluid or salt intake, and medication that causes fluid retention such as [[Non-steroidal anti-inflammatory drug|NSAIDs]] and [[thiazolidinedione]]s, may also precipitate decompensation.<ref>{{cite journal |author=Nieminen MS, Böhm M, Cowie MR, ''et al.'' |title=Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology |journal=Eur. Heart J. |volume=26 |issue=4 |pages=384–416 |year=2005 |month=February |pmid=15681577 |doi=10.1093/eurheartj/ehi044 |url=http://eurheartj.oxfordjournals.org/cgi/content/full/26/4/384}}</ref>


==Differential Diagnosis of the Underlying Causes of Heart Failure==
==Differential Diagnosis of the Underlying Causes of Heart Failure==

Revision as of 02:46, 2 April 2012

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

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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 causes On the Web

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US National Guidelines Clearinghouse

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FDA on Congestive heart failure causes

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Directions to Hospitals Treating Congestive heart failure causes

Risk calculators and risk factors for Congestive heart failure causes

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

Overview

There are several general causes of heart failure. Heart failure may be of pericardial origin such as tamponade and pericardial constriction, of valvular origin such as aortic or mitral regurgitation; of myocardial origin such as idiopathic dilated cardiomyopathy, familial dilated cardiomyopathy, ischemic cardiomyopathy, valvular heart disease; or of coronary vascular origin such as acute ischemic episodes, and rhythm disturbances such as tachycardia-induced heart failure. Other common secondary causes include anemia, obesity,drugs [(such as first generation calcium channel blockers, disopyramide, and sotalol, NSAIDs (may cause fluid retention), beta blockers (may cause heart failure with their negative inotropic effects)].

Causes of Acute or Decompensated Heart Failure

Chronic stable heart failure may easily decompensate. This most commonly results from an intercurrent illness (such as pneumonia), myocardial infarction (a heart attack), arrhythmias, uncontrolled hypertension, or a patient's failure to maintain a fluid restriction, diet, or medication.[1] Other well recognized precipitating factors include anemia and hyperthyroidism which place additional strain on the heart muscle. Excessive fluid or salt intake, and medication that causes fluid retention such as NSAIDs and thiazolidinediones, may also precipitate decompensation.[2]

Differential Diagnosis of the Underlying Causes of Heart Failure

Heart Failure Secondary to Coronary Artery Disease

A. Underlying Mechanisms

  1. Ischemic Preconditioning
    • Reductions in ischemia-related apoptosis
    • Increases in endogenous adenosine
    • Activation of potassium-adenosine triphosphate (K+-ATP) channels
  2. Electrical Dysfunction
    • QT prolongation
    • Increased susceptibility to arrhythmia
    • QT dispersion
  3. Mechanical Dysfunction
    • Systolic dysfunction
    • Diastolic dysfunction
  4. Biochemical Dysfunction
    • Increases in beta-adrenergic receptor density
    • Changes in structural and regulatory proteins
    • Shift to FFA as a proffered metabolic substrate
    • Lactate production
    • Elevated BNP concentration

B. Utilisation of Clinical Data

Management of heart failure due to coronary artery disease are primarily influenced by following parameters:

  1. An estimate of the relative proportions of:
    • Viable but ischemic myocardium
    • Nonviable myocardium
    • Viable non-ischemic myocardium
  2. The technical feasibility of successful mechanical revascularization
  3. The extent and severity of comorbidities in the individual patient

Cardiomyopathies and Inflammatory Diseases

Restrictive Cardiomyopathies
Dilated Cardiomyopathies
Inflammations

Congestive Heart Failure as a Consequence of Valvular Heart Disease

Congestive Hert Failure Secondary to Congenital Heart Disease

A. Causes of Congestive Heart Failure in Adults with Unoperated Congenital Heart Diseases

B. Causes of Congestive Heart Failure in Adults with Operated Congenital Heart Diseases

Right Ventricular Failure

Factors affected right ventricle and to be eliminated during management of congestive heart failure. A. Right ventricular myocardial dysfunction

  1. Right ventricular myocardial infarction
  2. Dilated cardiomyopathy
  3. Right ventricular dysplasia

B. Primary right ventricular pressure overload

  1. Left ventricular failure
  2. Mitral valve disease
  3. Atrial myxoma
  4. Pulmonary veno-occlusive disease
  5. Cor pulmonale
  6. Pulmonic stenosis
  7. Ventricular septal defect
  8. Aortopulmonary communication

C. Primary right ventricular volume overload

  1. Pulmonic regurgitation
  2. Tricuspid regurgitation
  3. Atrial septal defect
  4. Partial anomalous pulmonary venous return

D. Impediment to right ventricular inflow

  1. Tricuspid stenosis
  2. Cardiac tamponade
  3. Constrictive pericarditis
  4. Restrictive cardiomyopathy

Differential Diagnosis of Causes of Heart Failure

A. Left Ventricular Failure

Most Common Causes:

Expanded List of Causes:

B. Right Ventricular Failure

Most Common Causes:

Other Causes:

C. Others


References

  1. ↑ Fonarow GC, Abraham WT, Albert NM; et al. (2008). "Factors Identified as Precipitating Hospital Admissions for Heart Failure and Clinical Outcomes: Findings From OPTIMIZE-HF". Arch. Intern. Med. 168 (8): 847–854. doi:10.1001/archinte.168.8.847. PMID 18443260. Unknown parameter |month= ignored (help)
  2. ↑ Nieminen MS, Böhm M, Cowie MR; et al. (2005). "Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology". Eur. Heart J. 26 (4): 384–416. doi:10.1093/eurheartj/ehi044. PMID 15681577. Unknown parameter |month= ignored (help)

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