Congestive heart failure treatment of underlying causes: Difference between revisions
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Patients with bilateral [[renal artery stenosis]] tend to have a greater risk of flash [[pulmonary edema]] than those patients with unilateral [[renal artery stenosis]]<ref name="pmid2900930">{{cite journal |author=Pickering TG, Herman L, Devereux RB, Sotelo JE, James GD, Sos TA, Silane MF, Laragh JH |title=Recurrent pulmonary oedema in hypertension due to bilateral renal artery stenosis: treatment by angioplasty or surgical revascularisation |journal=[[Lancet]] |volume=2 |issue=8610 |pages=551–2 |year=1988 |month=September |pmid=2900930 |doi= |url= |issn= |accessdate=2013-a04-25}}</ref>. This combination of flash [[pulmonary edema]] and bilateral [[renal artery stenosis]] is known as [[Pickering syndrome]]<ref name="pmid21406441">{{cite journal |author=Messerli FH, Bangalore S, Makani H, Rimoldi SF, Allemann Y, White CJ, Textor S, Sleight P |title=Flash pulmonary oedema and bilateral renal artery stenosis: the Pickering syndrome |journal=[[European Heart Journal]] |volume=32 |issue=18 |pages=2231–5 |year=2011 |month=September |pmid=21406441 |doi=10.1093/eurheartj/ehr056 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=21406441 |issn= |accessdate=2013-04-25}}</ref>. 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. | Patients with bilateral [[renal artery stenosis]] tend to have a greater risk of flash [[pulmonary edema]] than those patients with unilateral [[renal artery stenosis]]<ref name="pmid2900930">{{cite journal |author=Pickering TG, Herman L, Devereux RB, Sotelo JE, James GD, Sos TA, Silane MF, Laragh JH |title=Recurrent pulmonary oedema in hypertension due to bilateral renal artery stenosis: treatment by angioplasty or surgical revascularisation |journal=[[Lancet]] |volume=2 |issue=8610 |pages=551–2 |year=1988 |month=September |pmid=2900930 |doi= |url= |issn= |accessdate=2013-a04-25}}</ref>. This combination of flash [[pulmonary edema]] and bilateral [[renal artery stenosis]] is known as [[Pickering syndrome]]<ref name="pmid21406441">{{cite journal |author=Messerli FH, Bangalore S, Makani H, Rimoldi SF, Allemann Y, White CJ, Textor S, Sleight P |title=Flash pulmonary oedema and bilateral renal artery stenosis: the Pickering syndrome |journal=[[European Heart Journal]] |volume=32 |issue=18 |pages=2231–5 |year=2011 |month=September |pmid=21406441 |doi=10.1093/eurheartj/ehr056 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=21406441 |issn= |accessdate=2013-04-25}}</ref>. 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. | ||
==Valvular Heart Disease== | |||
In 10% to 12% of patients, valvular heart disease is the underlying cause of congestive heart failure<ref name="pmid12748317">{{cite journal |author=Jessup M, Brozena S |title=Heart failure |journal=[[The New England Journal of Medicine]] |volume=348 |issue=20 |pages=2007–18 |year=2003 |month=May |pmid=12748317 |doi=10.1056/NEJMra021498 |url=http://www.nejm.org/doi/abs/10.1056/NEJMra021498?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |issn= |accessdate=2013-04-25}}</ref>. | |||
==References== | ==References== | ||
Revision as of 00:28, 26 April 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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:
- To improve symptoms.
- 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.
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:
- Beta blockers
- Angiotensin-converting enzyme inhibitors
- Angiotensin receptor blockers in patients who cannot tolerate a angiotensin converting enzyme inhibitor
- Aldosterone antagonists
Patients with bilateral renal artery stenosis tend to have a greater risk of flash pulmonary edema than those patients with unilateral renal artery stenosis[2]. This combination of flash pulmonary edema and bilateral renal artery stenosis is known as Pickering syndrome[3]. 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.
Valvular Heart Disease
In 10% to 12% of patients, valvular heart disease is the underlying cause of congestive heart failure[4].
References
- ↑ 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) - ↑ 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) - ↑ 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) - ↑ 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)