Cardiology overview heart failure
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Cardiology Overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Pharmacotherapy
Angiotensin Converting Enzyme (ACE) Inhibition
- Improve LV remodeling following ST elevation MI
- Even in patients who are asymptomatic with LV dysfunction, this class improves the odds of developing symptoms and survival.
Lasix
- Higher lasix doses are associated with higher mortality, likely as a surrogate of disease severity rather than part of a causal pathway.
Digoxin
- Digoxin has not been associated with improvement in survival. It has been associated with a reduction in rehospitalization. In the DIG trial, the most effective and safest levels of digoxin were levels less than 1 ng/mL. levels greater than 1 ng/ml were no more effective and were associated with a trend towards higher mortality.
Beta Blockers
Lopressor should be used instead of atenolol in the patient with CHF
Metformin
Enoxaparin and Antiocagulation
- While hospitalized, patients with CHF should receive DVT prophylaxis
Drugs to Avoid in CHF
- Dronedarone should be avoided in patients who were hospitalized with CHF (this is a boxed warning)
- Sotalol (has a negative inotropic effect)
Mechanical Therapy
- Cardiac resynchronization therapy has been associated with improvement in symptoms and a reduction in hospitalizations.
- Cardiac recent organization therapy should only be undertaken if the blood pressure is low and if the heart failure medicines have been optimized
ACC / AHA Guidelines - Recommendations for Cardiac Resynchronization Therapy in Patients with Severe Systolic Heart Failure (DO NOT EDIT)[1]
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Class I
1) For patients who have LVEF less than or equal to 35%, a QRS duration greater than or equal to 0.12 seconds, and sinus rhythm, CRT with or without an ICD is indicated for the treatment of NYHA functional Class III or ambulatory Class IV heart failure symptoms with optimal recommended medical therapy. (Level of Evidence: A)
Class IIa
1) For patients who have LVEF less than or equal to 35%, a QRS duration greater than or equal to 0.12 seconds, and AF, CRT with or without an ICD is reasonable for the treatment of NYHA functional Class III or ambulatory Class IV heart failure symptoms on optimal recommended medical therapy. (Level of Evidence: B)
2) For patients with LVEF less than or equal to 35% with NYHA functional Class III or ambulatory Class IV symptoms who are receiving optimal recommended medical therapy and who have frequent dependence on ventricular pacing, CRT is reasonable. (Level of Evidence: C)
Class IIb
1) For patients with LVEF less than or equal to 35% with NYHA functional Class I or II symptoms who are receiving optimal recommended medical therapy and who are undergoing implantation of a permanent pacemaker and/or ICD with anticipated frequent ventricular pacing, CRT may be considered. (Level of Evidence: C)
Ultrafiltration
- Ultrafiltration has been associated with a reduced incidence of hospitalization compared with diuretics in the UNLOAD trial. There was no difference in mortality.
Invasive Monitoring
- Based upon the results of the ESCAPE trial, there is no benefit in clinical outcomes with the use of a pulmonary artery line in patients with decompensated CHF.
Obstructive Sleep Apnea in the Patient with CHF
- Central sleep apnea in the patient with CHF is due to the compensatory respiratory alkalosis that is present in the patient with CHF and tachypnea
References
- ↑ Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW (2008). "ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons". Circulation. 117 (21): e350–408. doi:10.1161/CIRCUALTIONAHA.108.189742. PMID 18483207. Retrieved 2011-01-15. Unknown parameter
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