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: Mahmoud Sakr, M.D. [2]

Definition

Heart failure is a complex syndrome whereby there is inadequate output of the heart to meet the metabolic demands of the body. Abnormal function of different anatomic parts of the heart cause heart failure including the pericardium, the myocardium, the endocardium, the heart valves and the great vessels. Symptoms of heart failure are due to a lack of both forward blood flow to the body, and backward flow into the lungs. Heart failure is a clinical syndrome characterized by symptoms of dyspnea, edema and fatigue and signs such as rales on physical examination.

Causes

Life Threatening Causes

Conditions that may cause death or permanent disability within the next 24 hours

• Accelerated hypertension
• Acute kidney injury
• Acute myocardial ischemia
• Acute or progressive valvular disease (e.g. acute mitral regurgitation)
• Acute or subacute valve disease endocarditis
• Aortic dissection
• Cardiac arrhythmias, specially ventricular arrhythmias
• Cardiotoxic agents (e.g. alcohol, cocaine, and certain chemotherapy drugs)
• Diabetic emergencies (e.g. ketoacidosis)
• Myopericarditis
• Pulmonary embolus
• Severe anemia (e.g. acute hemolysis or blood loss)
• Systemic Inflammatory response syndrome
• Thyrotoxicosis

Common Causes

• Accelerated hypertension
• Acute kidney injury
• Acute myocardial ischemia
• Acute or progressive valvular disease (e.g. acute mitral regurgitation)
• Cardiac arrhythmias
• Excessive alcohol or illicit drug use (e.g. cocaine)
• Hypertension
• Myocardial ischemia
• Pulmonary embolus
• Systemic Inflammatory response syndrome

Management

• Acute HF will most likely fall in the stage C or stage D of the ACC/AHA HF classification. see figure 1

Figure 1: Stages in the development of HF:

Determine ACC/AHA stage of HF

STAGE A At high risk for HF but without structural heart disease or symptoms of HF

STAGE B Structural heart disease but without signs or symptoms of HF

STAGE C Structural heart disease with prior or current symptoms of HF

STAGE D Refractory HF

References

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