Congestive heart failure

Resident Survival Guide

Congestive Heart Failure Microchapters
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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
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2], Seyedmahdi Pahlavani, M.D. [3] Syed Hassan A. Kazmi BSc, MD [4]

Synonyms and keywords: CHF; pump failure; left heart failure; chronic heart failure; acute heart failure; LV dysfunction; LV failure; impaired filling; reduced cardiac output; HFpEF; HFrEF; heart failure preserved ejection fraction; heart failure reduced ejection fraction; decompensated heart failure; acute decompensated heart failure; ADHF

Pathophysiology

Systolic dysfunction | Diastolic dysfunction | HFpEF | HFrEF

Diagnosis

Clinical Assessment | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X Ray | Echocardiography | Cardiac MRI | Exercise Stress Test | Myocardial Viability Studies | Cardiac Catheterization | Invasive hemodynamic monitoring

Treatment

Treatment of Heart failure with reduced ejection fraction

Pharmacological treatments for patients with heart failure with reduced ejection fraction:

• All patients: ACE Inhibitors | Beta Blockers | Aldosterone Antagonists | Angiotensin Receptor-Neprilysin Inhibitor | Sodium-glucose co-transporter 2 inhibitors |
• In selected patients: Diuretics | Angiotensin receptor blockers | I_f-channel inhibitor | Combination of hydralazine and isosorbide dinitrate | Digoxin

Cardiac rhythm management for patients with heart failure with reduced ejection fraction:

• Implantable cardioverter defibrillator | Cardiac resynchronization therapy

Treatment of Heart failure with mildly reduced ejection fraction

Angiotensin-converting enzyme inhibitors | Angiotensin receptor II type 1 blockers | Beta-blockers | Mineralocorticoid receptor antagonists | Angiotensin receptor-neprilysin inhibitor | Other drugs | Devices

Management of Acute heart failure

Oxygen therapy and/or ventilatory support Diuretics Vasodilators Inotropes Vasopressors Opiates Digoxin Thromboembolism prophylaxis Short-term mechanical circulatory support Pre-discharge assessment and post-discharge management planning

Managementof Advanced heart failure

Pharmacological therapy Renal replacement Mechanical circulatory support Heart transplantation Symptom control and end-of-life care

Secondary prevention

Nonpharmacological Interventions: Education Social Support Sodium Restriction: Recommendation Treatment of Sleep Disorders Weight Loss Activity, Exercise Prescription, and Cardiac Rehabilitation Patient education, self-care and lifestyle advice | Exercise rehabilitation | ==== Exercise Training ====

Follow-up of chronic heart failure Telemonitoring

Treatment of underlying causes | Associated conditions

Acute Pharmacotherapy

Chronic Pharmacotherapy in HFpEF

Chronic Pharmacotherapy in HFrEF:

Drugs to Avoid | Drug Interactions

Chronic Pharmacotherapy in HFpEF

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT) | Implantation of Intracardiac Defibrillator | Ultrafiltration | Left Ventricular Assist Devices (LVADs) | Cardiac Transplantation | Cardiac Surgery

ACC/AHA Guideline Recommendations

Stage A: Patients at High Risk for Developing Heart Failure

Treatment of Hypertension | Treatment of Diabetes Mellitus | Management of Metabolic Syndrome | Management of Atherosclerotic Disease | Control of Conditions That May Cause Heart Failure | ACC/AHA Guideline Recommendations

Specific Groups

Special Populations | Patients who have concomitant disorders | Obstructive Sleep Apnea in the Patient with CHF

Sources

• The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

• 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