This document provides an overview of heart failure, including:
1. It defines heart failure and classifies it based on ACCF/AHA stages and NYHA functional classification.
2. It outlines recommendations for diagnostic tests, noninvasive imaging, invasive evaluation, and pharmacological and nonpharmacological treatment for stages A through D.
3. It discusses surgical interventions for heart failure such as ventricular reduction procedures, coronary artery bypass grafting, valve surgery, and cardiac transplantation.
This document provides an outline on heart failure, covering definitions, etiology, pathophysiology, clinical manifestations, complications, diagnosis, and management. Heart failure is defined as a condition where the heart cannot pump enough blood to meet the body's needs. The most common causes are high blood pressure and structural heart issues. The pathophysiology involves compensatory mechanisms like activation of the sympathetic nervous system and renin-angiotensin-aldosterone system. Clinical manifestations include dyspnea, edema, fatigue, and liver enlargement. Management involves drug therapy like diuretics and ACE inhibitors, as well as lifestyle changes like sodium and fluid restriction.
1) Heart failure is a major and growing public health problem, affecting over 15 million people in Europe with a prevalence of over 2-3% overall and 10-20% in those over 70 years old.
2) It is a primary cause of hospital admissions and readmissions, accounting for 5% of admissions and 40% of patients being readmitted or dying within a year. It represents a significant cost burden on healthcare systems.
3) Diagnosis involves clinical examination, ECG, chest x-ray, echocardiography and natriuretic peptide levels of BNP or NT-proBNP which can help differentiate between possible and likely heart failure.
4) Heart failure is now recognized as a
Heart failure - pathogenesis and current managementSubhasish Deb
1. Heart failure is defined as the inability of the heart to pump enough blood to meet the body's needs. It can occur when the heart muscle is damaged or weakened.
2. The document discusses the pathogenesis, stages, evaluation, and management of heart failure. Compensatory mechanisms initially help the heart function but eventually cause harm through remodeling if the underlying issue is not addressed.
3. Treatment involves controlling risk factors, using medications like ACE inhibitors and beta blockers, and devices like ICDs and CRT for more advanced cases. Ongoing monitoring is important as the condition can progress despite treatment.
Heart failure is a clinical syndrome characterized by dyspnea, fatigue, and clinical signs of congestion leading to frequent hospitalizations, poor quality of life, and shortened life expectancy. It is a final common pathway to various cardiac conditions. It is a growing problem worldwide with serious consequences in Sub-Saharan Africa where it occurs at a younger age with limited resources to manage the condition. The incidence and prevalence vary worldwide. In this mini-review, we looked at the definition, classification, and pathophysiology of the condition.
This document discusses the management and treatment of patients with advanced heart failure who require admission to the intensive care unit (ICU). It defines advanced heart failure and provides criteria for determining which heart failure patients should be admitted to the ICU. It covers monitoring in the ICU, classification of heart failure, medical treatment including diuretics and inotropic drugs, and mechanical circulatory support options. The future of treatments like ventricular assist devices is also mentioned.
This document discusses heart failure, including causes, symptoms, classifications, treatment options and guidelines. It covers systolic and diastolic heart failure, risk factors, physical findings, NYHA functional classes, medications like ACE inhibitors, beta blockers, ARBs and more. It also discusses device options, special populations like African Americans, and the cardio-renal syndrome.
Evidence based diagnosis and management of heart failureDivya Bagoria
This document provides an overview of evidence-based diagnosis and management of heart failure. It discusses what heart failure is, epidemiology, types based on ejection fraction, acute vs chronic heart failure, common comorbidities, causes, pathophysiology, clinical features including symptoms and staging. It covers differential diagnosis, guidelines for diagnosis including levels of evidence and recommendations. Assessment of left ventricular function using echocardiogram and biomarkers are summarized.
This document provides an outline on heart failure, covering definitions, etiology, pathophysiology, clinical manifestations, complications, diagnosis, and management. Heart failure is defined as a condition where the heart cannot pump enough blood to meet the body's needs. The most common causes are high blood pressure and structural heart issues. The pathophysiology involves compensatory mechanisms like activation of the sympathetic nervous system and renin-angiotensin-aldosterone system. Clinical manifestations include dyspnea, edema, fatigue, and liver enlargement. Management involves drug therapy like diuretics and ACE inhibitors, as well as lifestyle changes like sodium and fluid restriction.
1) Heart failure is a major and growing public health problem, affecting over 15 million people in Europe with a prevalence of over 2-3% overall and 10-20% in those over 70 years old.
2) It is a primary cause of hospital admissions and readmissions, accounting for 5% of admissions and 40% of patients being readmitted or dying within a year. It represents a significant cost burden on healthcare systems.
3) Diagnosis involves clinical examination, ECG, chest x-ray, echocardiography and natriuretic peptide levels of BNP or NT-proBNP which can help differentiate between possible and likely heart failure.
4) Heart failure is now recognized as a
Heart failure - pathogenesis and current managementSubhasish Deb
1. Heart failure is defined as the inability of the heart to pump enough blood to meet the body's needs. It can occur when the heart muscle is damaged or weakened.
2. The document discusses the pathogenesis, stages, evaluation, and management of heart failure. Compensatory mechanisms initially help the heart function but eventually cause harm through remodeling if the underlying issue is not addressed.
3. Treatment involves controlling risk factors, using medications like ACE inhibitors and beta blockers, and devices like ICDs and CRT for more advanced cases. Ongoing monitoring is important as the condition can progress despite treatment.
Heart failure is a clinical syndrome characterized by dyspnea, fatigue, and clinical signs of congestion leading to frequent hospitalizations, poor quality of life, and shortened life expectancy. It is a final common pathway to various cardiac conditions. It is a growing problem worldwide with serious consequences in Sub-Saharan Africa where it occurs at a younger age with limited resources to manage the condition. The incidence and prevalence vary worldwide. In this mini-review, we looked at the definition, classification, and pathophysiology of the condition.
This document discusses the management and treatment of patients with advanced heart failure who require admission to the intensive care unit (ICU). It defines advanced heart failure and provides criteria for determining which heart failure patients should be admitted to the ICU. It covers monitoring in the ICU, classification of heart failure, medical treatment including diuretics and inotropic drugs, and mechanical circulatory support options. The future of treatments like ventricular assist devices is also mentioned.
This document discusses heart failure, including causes, symptoms, classifications, treatment options and guidelines. It covers systolic and diastolic heart failure, risk factors, physical findings, NYHA functional classes, medications like ACE inhibitors, beta blockers, ARBs and more. It also discusses device options, special populations like African Americans, and the cardio-renal syndrome.
Evidence based diagnosis and management of heart failureDivya Bagoria
This document provides an overview of evidence-based diagnosis and management of heart failure. It discusses what heart failure is, epidemiology, types based on ejection fraction, acute vs chronic heart failure, common comorbidities, causes, pathophysiology, clinical features including symptoms and staging. It covers differential diagnosis, guidelines for diagnosis including levels of evidence and recommendations. Assessment of left ventricular function using echocardiogram and biomarkers are summarized.
This document discusses the diagnosis and management of acute heart failure in critically ill patients. It covers early recognition through assessing severity, resuscitation of breathing and circulation, determining etiology with tests like ECG, chest X-ray and biomarkers, and principles of management including reducing demand, increasing supply, and correcting structural problems. Cardiogenic shock, a severe form of heart failure, is also defined.
Diagnosis and management of acute heart failureAlaa Ateya
Acute heart failure (AHF) can be defined as new or worsening symptoms of heart failure requiring urgent medical care or hospitalization. Common triggers include non-adherence to medications or diet, infections, or worsening of underlying comorbidities like hypertension. This leads to worsening congestion through mechanisms like neurohormonal activation and myocardial injury. Around half of AHF patients have preserved ejection fraction. Ongoing myocardial damage, worsening kidney function, and elevated filling pressures all contribute to poor outcomes of AHF patients.
A brief synopsis of acute decompensated heart failureDr Emad efat
This document provides an overview of acute decompensated heart failure (ADHF). It defines ADHF as a clinical syndrome characterized by the development of respiratory distress due to rapidly accumulated fluid in the lungs. The document categorizes heart failure based on systolic vs diastolic function, left vs right sided, acute vs chronic onset, and NYHA functional classification. Common symptoms, physical exam findings, causes, risk factors, differential diagnoses, and initial investigations are described. Imaging findings on chest x-ray indicative of different stages of heart failure are also summarized.
Comprehensive approach to managing heart Failure Patientdrucsamal
The document discusses Korea's comprehensive approach to managing heart failure (HF) patients through a multidisciplinary team approach. Some key points:
1) HF prevalence in Korea is increasing, while device therapies like ICD, CRT, ECMO, and LVAD as well as heart transplants have also increased in recent years.
2) The comprehensive HF management program in Severance Hospital utilizes an integrated, interdisciplinary, and patient-centered approach including drug optimization, education, monitoring, management of comorbidities, and transitions of care.
3) A multidisciplinary heart failure team consisting of specialists, nurses, dietitians and more conduct monthly meetings and provide programs like cardiac rehabilitation and a nurse-
This document discusses heart failure (also known as congestive heart failure), which refers to the heart's inability to pump enough blood to meet the body's needs. It defines heart failure and lists some common causes such as hypertension, coronary artery disease, and cardiomyopathy. Signs and symptoms like shortness of breath, edema, and fatigue are described. Diagnostic tests and the goals of medical management to relieve symptoms, improve quality of life, and prevent exacerbations are also summarized.
Heart failure Update as per, 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the
Management of Heart Failure and 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
This document provides an overview of the management of acute left ventricular failure (ALVF). It begins with definitions and causes of acute heart failure and ALVF. The pathophysiology, signs and symptoms, classifications, diagnosis and differential diagnosis of ALVF are described. The goals and algorithms for treatment in the emergency department and pharmacological therapies including diuretics, vasodilators, inotropes, vasopressors and other drugs are summarized. Non-pharmacological therapies, mechanical circulatory support, post-stabilization care, and long-term management are also outlined. The document concludes with a discussion of potential new therapies, prognosis, and underlying diseases/comorbidities in acute heart failure.
1. The 2012 Focused Update provides updated guidelines for the diagnosis and management of heart failure in adults.
2. It emphasizes the progressive nature of left ventricular dysfunction and stages of heart failure from risk to end-stage disease.
3. New mechanisms and models of heart failure are discussed, including the cardiorenal model, hemodynamic model, and neurohormonal hypothesis.
This document discusses outpatient management of heart failure. It defines heart failure and describes its prevalence, incidence, classification, prognosis, clinical diagnosis and evaluation. It outlines a staged approach to heart failure therapy based on the presence or absence of symptoms and structural heart disease. Key recommendations include use of ACE inhibitors, ARBs, beta-blockers, aldosterone antagonists, diuretics, digoxin, and devices like ICDs and CRT depending on the stage of heart failure.
The document presents a case study of a 66-year-old female patient admitted to the cardiology department with complaints of chest pain, shortness of breath, fever, and weakness for 3-4 days. Examinations found moderate left ventricular systolic dysfunction and an abnormal ECG. The patient was diagnosed with congestive heart failure, fever, arrhythmias, acidity, angina, constipation, and high cholesterol and treated accordingly with medications and lifestyle counseling.
This document provides an overview of heart failure, including its definition, pathophysiology, types, causes, symptoms, diagnosis, prognosis, and treatment options. It discusses systolic and diastolic heart failure, highlighting key differences. Medical treatments that improve survival in systolic heart failure are reviewed, including ACE inhibitors, beta blockers, spironolactone/eplerenone, hydralazine/nitrates, and ARBs. The roles of diuretics, neurohormonal activation, and beta blockers are explained. Carvedilol is positioned as superior to metoprolol based on direct comparison trials.
This document provides information on heart failure, including:
1) It defines heart failure and discusses its epidemiology, types, prognosis, and basic mechanisms including systolic and diastolic dysfunction.
2) It covers left ventricular remodeling, diagnosis including biomarkers and imaging, and management of acute heart failure syndromes.
3) It discusses pharmacological treatments for chronic heart failure including vasodilators, inotropic agents, vasopressin antagonists, and diuretics.
The document discusses heart failure, including its definition, stages, causes, symptoms, and treatment guidelines. It provides an overview of epidemiology and costs of heart failure. Guidelines from ACC/AHA classify heart failure into stages A through D based on risk or presence of symptoms. Treatment involves managing risk factors, addressing neurohormonal activation, and following medication protocols tailored to each stage.
Guideline for the management of heart failureIqbal Dar
This document provides guidelines for the management of heart failure. It defines heart failure and outlines the stages from A to D. It recommends obtaining a thorough history and physical exam, diagnostic tests including biomarkers, and noninvasive cardiac imaging for initial and serial evaluation of heart failure patients. Invasive hemodynamic monitoring is recommended for selected patients with acute heart failure and impaired perfusion. Invasive coronary angiography is reasonable when ischemia may be contributing to heart failure.
1. Congestive cardiac failure (CCF) occurs when the heart cannot pump enough blood to meet the body's needs due to conditions like coronary artery disease, hypertension, or cardiomyopathy.
2. Treatment depends on the cause, severity, and patient's health, and may include medications, surgery, or lifestyle changes. Common medications include diuretics, ACE inhibitors, beta blockers, and cardiac glycosides like digoxin.
3. Surgery such as valve replacement or angioplasty may be used in some cases. Lifestyle modifications involve reducing sodium and fluid intake, exercising mildly, and taking diuretics as prescribed. Current clinical trials are investigating new treatments and comparing existing medications.
Congestive heart failure can be caused by conditions that weaken the heart muscle or overload it. The main symptoms are shortness of breath, fatigue, cough, and fluid retention. Treatment focuses on correcting reversible causes, reducing fluid overload with diuretics, and inhibiting the renin-angiotensin-aldosterone system with ACE inhibitors. Other medications like beta blockers, digitalis, and vasodilators may also be used depending on the individual case. Monitoring through physical exams, labs, and imaging can help guide management and prevent exacerbations.
This document provides guidelines for the management of heart failure. It defines heart failure and classifies it based on ejection fraction into heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). It recommends treatments for each stage of heart failure, including using ACE inhibitors, ARBs, beta blockers, aldosterone antagonists, and diuretics to treat HFrEF based on the patient's symptoms and ejection fraction. The guidelines provide dosing and efficacy evidence for each drug therapy. It recommends controlling risk factors and comorbidities for early stages of heart failure and using biomarkers and imaging to assist in diagnosis and management.
2009 Focused Update:
ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults
J. Am. Coll. Cardiol. April 14, 2009; 53;1343-1382
Circulation. April 14, 2009;119;1977-2016
This document discusses the diagnosis and management of acute heart failure in critically ill patients. It covers early recognition through assessing severity, resuscitation of breathing and circulation, determining etiology with tests like ECG, chest X-ray and biomarkers, and principles of management including reducing demand, increasing supply, and correcting structural problems. Cardiogenic shock, a severe form of heart failure, is also defined.
Diagnosis and management of acute heart failureAlaa Ateya
Acute heart failure (AHF) can be defined as new or worsening symptoms of heart failure requiring urgent medical care or hospitalization. Common triggers include non-adherence to medications or diet, infections, or worsening of underlying comorbidities like hypertension. This leads to worsening congestion through mechanisms like neurohormonal activation and myocardial injury. Around half of AHF patients have preserved ejection fraction. Ongoing myocardial damage, worsening kidney function, and elevated filling pressures all contribute to poor outcomes of AHF patients.
A brief synopsis of acute decompensated heart failureDr Emad efat
This document provides an overview of acute decompensated heart failure (ADHF). It defines ADHF as a clinical syndrome characterized by the development of respiratory distress due to rapidly accumulated fluid in the lungs. The document categorizes heart failure based on systolic vs diastolic function, left vs right sided, acute vs chronic onset, and NYHA functional classification. Common symptoms, physical exam findings, causes, risk factors, differential diagnoses, and initial investigations are described. Imaging findings on chest x-ray indicative of different stages of heart failure are also summarized.
Comprehensive approach to managing heart Failure Patientdrucsamal
The document discusses Korea's comprehensive approach to managing heart failure (HF) patients through a multidisciplinary team approach. Some key points:
1) HF prevalence in Korea is increasing, while device therapies like ICD, CRT, ECMO, and LVAD as well as heart transplants have also increased in recent years.
2) The comprehensive HF management program in Severance Hospital utilizes an integrated, interdisciplinary, and patient-centered approach including drug optimization, education, monitoring, management of comorbidities, and transitions of care.
3) A multidisciplinary heart failure team consisting of specialists, nurses, dietitians and more conduct monthly meetings and provide programs like cardiac rehabilitation and a nurse-
This document discusses heart failure (also known as congestive heart failure), which refers to the heart's inability to pump enough blood to meet the body's needs. It defines heart failure and lists some common causes such as hypertension, coronary artery disease, and cardiomyopathy. Signs and symptoms like shortness of breath, edema, and fatigue are described. Diagnostic tests and the goals of medical management to relieve symptoms, improve quality of life, and prevent exacerbations are also summarized.
Heart failure Update as per, 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the
Management of Heart Failure and 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
This document provides an overview of the management of acute left ventricular failure (ALVF). It begins with definitions and causes of acute heart failure and ALVF. The pathophysiology, signs and symptoms, classifications, diagnosis and differential diagnosis of ALVF are described. The goals and algorithms for treatment in the emergency department and pharmacological therapies including diuretics, vasodilators, inotropes, vasopressors and other drugs are summarized. Non-pharmacological therapies, mechanical circulatory support, post-stabilization care, and long-term management are also outlined. The document concludes with a discussion of potential new therapies, prognosis, and underlying diseases/comorbidities in acute heart failure.
1. The 2012 Focused Update provides updated guidelines for the diagnosis and management of heart failure in adults.
2. It emphasizes the progressive nature of left ventricular dysfunction and stages of heart failure from risk to end-stage disease.
3. New mechanisms and models of heart failure are discussed, including the cardiorenal model, hemodynamic model, and neurohormonal hypothesis.
This document discusses outpatient management of heart failure. It defines heart failure and describes its prevalence, incidence, classification, prognosis, clinical diagnosis and evaluation. It outlines a staged approach to heart failure therapy based on the presence or absence of symptoms and structural heart disease. Key recommendations include use of ACE inhibitors, ARBs, beta-blockers, aldosterone antagonists, diuretics, digoxin, and devices like ICDs and CRT depending on the stage of heart failure.
The document presents a case study of a 66-year-old female patient admitted to the cardiology department with complaints of chest pain, shortness of breath, fever, and weakness for 3-4 days. Examinations found moderate left ventricular systolic dysfunction and an abnormal ECG. The patient was diagnosed with congestive heart failure, fever, arrhythmias, acidity, angina, constipation, and high cholesterol and treated accordingly with medications and lifestyle counseling.
This document provides an overview of heart failure, including its definition, pathophysiology, types, causes, symptoms, diagnosis, prognosis, and treatment options. It discusses systolic and diastolic heart failure, highlighting key differences. Medical treatments that improve survival in systolic heart failure are reviewed, including ACE inhibitors, beta blockers, spironolactone/eplerenone, hydralazine/nitrates, and ARBs. The roles of diuretics, neurohormonal activation, and beta blockers are explained. Carvedilol is positioned as superior to metoprolol based on direct comparison trials.
This document provides information on heart failure, including:
1) It defines heart failure and discusses its epidemiology, types, prognosis, and basic mechanisms including systolic and diastolic dysfunction.
2) It covers left ventricular remodeling, diagnosis including biomarkers and imaging, and management of acute heart failure syndromes.
3) It discusses pharmacological treatments for chronic heart failure including vasodilators, inotropic agents, vasopressin antagonists, and diuretics.
The document discusses heart failure, including its definition, stages, causes, symptoms, and treatment guidelines. It provides an overview of epidemiology and costs of heart failure. Guidelines from ACC/AHA classify heart failure into stages A through D based on risk or presence of symptoms. Treatment involves managing risk factors, addressing neurohormonal activation, and following medication protocols tailored to each stage.
Guideline for the management of heart failureIqbal Dar
This document provides guidelines for the management of heart failure. It defines heart failure and outlines the stages from A to D. It recommends obtaining a thorough history and physical exam, diagnostic tests including biomarkers, and noninvasive cardiac imaging for initial and serial evaluation of heart failure patients. Invasive hemodynamic monitoring is recommended for selected patients with acute heart failure and impaired perfusion. Invasive coronary angiography is reasonable when ischemia may be contributing to heart failure.
1. Congestive cardiac failure (CCF) occurs when the heart cannot pump enough blood to meet the body's needs due to conditions like coronary artery disease, hypertension, or cardiomyopathy.
2. Treatment depends on the cause, severity, and patient's health, and may include medications, surgery, or lifestyle changes. Common medications include diuretics, ACE inhibitors, beta blockers, and cardiac glycosides like digoxin.
3. Surgery such as valve replacement or angioplasty may be used in some cases. Lifestyle modifications involve reducing sodium and fluid intake, exercising mildly, and taking diuretics as prescribed. Current clinical trials are investigating new treatments and comparing existing medications.
Congestive heart failure can be caused by conditions that weaken the heart muscle or overload it. The main symptoms are shortness of breath, fatigue, cough, and fluid retention. Treatment focuses on correcting reversible causes, reducing fluid overload with diuretics, and inhibiting the renin-angiotensin-aldosterone system with ACE inhibitors. Other medications like beta blockers, digitalis, and vasodilators may also be used depending on the individual case. Monitoring through physical exams, labs, and imaging can help guide management and prevent exacerbations.
This document provides guidelines for the management of heart failure. It defines heart failure and classifies it based on ejection fraction into heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). It recommends treatments for each stage of heart failure, including using ACE inhibitors, ARBs, beta blockers, aldosterone antagonists, and diuretics to treat HFrEF based on the patient's symptoms and ejection fraction. The guidelines provide dosing and efficacy evidence for each drug therapy. It recommends controlling risk factors and comorbidities for early stages of heart failure and using biomarkers and imaging to assist in diagnosis and management.
2009 Focused Update:
ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults
J. Am. Coll. Cardiol. April 14, 2009; 53;1343-1382
Circulation. April 14, 2009;119;1977-2016
This document provides information on heart failure, including its definition, risk factors, causes, symptoms, classifications, diagnostic evaluations, and treatment recommendations. Heart failure is defined as a structural or functional impairment of ventricular filling or ejection of blood. Important risk factors include hypertension, diabetes, and atherosclerotic disease. Causes can be dilated cardiomyopathies, toxic cardiomyopathies, or inflammation-induced cardiomyopathies. Symptoms and signs are classified as typical or less typical. Treatment involves controlling risk factors, using medications like ACE inhibitors, beta blockers, and diuretics, and following lifestyle recommendations including sodium and fluid restrictions.
This document provides guidelines for the diagnosis and treatment of heart failure (HF) from the American College of Cardiology Foundation and American Heart Association. It classifies HF based on ejection fraction and symptoms. For stages A to D of HF, it lists recommendations for treatment including medications, devices, and procedures. It provides specific guidance for HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). The guidelines are meant to improve care for HF based on the latest evidence.
Heart failure is a complex clinical syndrome that results from structural or functional impairment of the ventricles. It is classified based on ejection fraction into HFrEF (≤40%) or HFpEF (≥50%).
For patients with HFrEF (stage C), treatment involves diuretics, ACE inhibitors, beta-blockers, aldosterone antagonists, hydralazine/isosorbide dinitrate, and digoxin. ACE inhibitors are recommended for all patients with HFrEF. Angiotensin receptor blockers are recommended for those intolerant to ACE inhibitors.
For HFpEF (stage C), treatment focuses on controlling blood pressure and symptoms of volume
This document summarizes two cases presented at a cardiology grand rounds meeting. Case 1 involves a 55-year-old male with ischemic dilated cardiomyopathy, heart failure with reduced ejection fraction, and coronary artery disease. Case 2 involves a 36-year-old male with non-ischemic dilated cardiomyopathy and heart failure with reduced ejection fraction. The document then reviews heart failure epidemiology, etiology, evaluation, classification, management, complications, and prognosis.
1. Rate control is the initial approach for elderly patients with minor AF symptoms, while rhythm control may be considered for symptomatic patients despite rate control.
2. Catheter ablation is recommended for symptomatic patients where medical therapy fails, and can be considered as initial therapy in some selected patients.
3. Anticoagulation is recommended for AF patients based on their stroke risk profile according to CHA2DS2-VASc score. Warfarin requires careful management during pregnancy.
The document provides guidelines from the 2013 ACCF/AHA/ESC/HFA for the diagnosis and management of heart failure. It outlines recommendations for initial evaluation of HF patients including history, physical exam, diagnostic tests, biomarkers, and noninvasive cardiac imaging. Invasive hemodynamic monitoring is recommended to guide therapy for patients with respiratory distress or impaired perfusion when intracardiac pressures cannot be determined clinically. The guidelines also cover treatment strategies for stages A through D of heart failure and management of hospitalized patients.
Heart Failure Care: How World-Class Performance is Within Your ReachHealth Catalyst
Less than 1% of heart failure (HF) patients with reduced ejection fraction are on target doses of all four drug classes within 12 months of an index hospitalization, yet these protocols have been proven to improve symptoms, slow disease progression, reduce costly admissions, and increase life expectancy. This data point must serve as a rallying cry in the nation’s quest to combat heart failure as a leading cause of death.
In this webinar, Dr. John Janas will:
Review the current HF treatment gaps
Discuss the latest evidence-based recommendations for changes to guideline-directed medical therapy (GDMT) and key changes to prior CHF guidelines
Explore the role that technology could play in improving HF care while reducing the burden on care teams
Samir Morcos Rafla is an emeritus professor of cardiology at Alexandria University who has published guidelines on acute heart failure. Heart failure can be chronic or acute, with acute heart failure defined as a rapid onset of symptoms requiring urgent therapy. It is classified based on systolic blood pressure into normotensive, hypertensive, non-hypertensive, and hypotensive subtypes. Acute heart failure is a global public health problem associated with high rates of hospitalization and mortality.
This document discusses heart failure, including its causes, types, symptoms, diagnosis, and treatment approaches. It notes that heart failure can be caused by abnormalities in systolic or diastolic cardiac function. Treatment involves managing underlying conditions, optimizing medication regimens including ACE inhibitors, ARBs, ARNIs, beta-blockers, diuretics, and device-based therapies, and making lifestyle modifications like sodium and fluid restriction. The goals are to improve quality of life, relieve symptoms, prevent hospitalizations, slow disease progression, and prolong survival for those with this chronic condition.
Acute and chronic heart failure (ESC guidline)Mohammad Uddin
This document summarizes guidelines from the 2016 European Society of Cardiology for the diagnosis and treatment of acute and chronic heart failure. It defines heart failure and the different types based on left ventricular ejection fraction. It describes symptoms and signs of heart failure, recommended tests for initial assessment and diagnosis, and algorithms for diagnosis. It provides guidance on treatments recommended for all symptomatic patients with reduced ejection fraction heart failure, as well as selected patients. The document concludes with practical guidance on the use of ACE inhibitors, beta blockers, and mineralocorticoid receptor antagonists in heart failure patients.
The document provides guidelines for the management of heart failure. It discusses the epidemiology of heart failure, classifications based on ejection fraction, stages based on symptoms and disease progression, and treatment recommendations for each stage. Key points include increasing risk with age, treatments including controlling risk factors in early stages and use of diuretics, ACE inhibitors, ARBs, and beta blockers in later stages, and tailored treatment for those with heart failure and comorbidities like diabetes or hypertension.
The document summarizes guidelines from the 2005 ACC/AHA update for the diagnosis and management of chronic heart failure in adults. The guidelines provide recommendations on the use of implantable cardioverter-defibrillators and cardiac resynchronization therapy for different stages of heart failure. They also recommend regular measurement of ejection fraction to help assess patients and determine treatment eligibility.
The document summarizes guidelines from the 2005 ACC/AHA update for the diagnosis and management of chronic heart failure in adults. The guidelines provide recommendations on device therapy and measurement of ejection fraction for different stages of heart failure. Key recommendations include implanting ICDs for primary prevention of sudden cardiac arrest in selected Stage B and C patients, and cardiac resynchronization therapy for mortality reduction in selected Stage C patients. Ejection fraction should be measured initially and may be repeated if a patient's status changes.
This document provides an overview of congestive heart failure (HF), including its epidemiology, types, diagnostic tests, treatment options, and management. Some key points:
- Nearly 5 million Americans currently live with HF, with over 550,000 new cases diagnosed yearly. It costs over $30 billion annually.
- HF occurs when the heart cannot pump sufficiently due to conditions like heart attack or hypertension damaging the heart muscle.
- Diagnostic tests include echocardiograms and BNP/NT-proBNP levels. HF is classified by ejection fraction and NYHA functional class.
- Treatment involves medications like ACE inhibitors, ARBs, beta blockers, and diuretics to manage symptoms. L
Heart Failure Guideline Recommendations for Device Therapy and Ejection Fract...MedicineAndFamily
The 2005 ACC/AHA guidelines for diagnosis and management of chronic heart failure updated recommendations for use of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT). The guidelines recommend ICDs for primary prevention of sudden cardiac death in selected patients for the first time. They also recommend CRT to reduce mortality and improve quality of life in selected patients. The guidelines classify recommendations and evidence, and provide recommendations on appropriate use of devices and measurement of ejection fraction for various stages of heart failure.
The 2005 ACC/AHA guidelines for diagnosis and management of chronic heart failure updated recommendations for use of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT). The guidelines recommend ICDs for primary prevention of sudden cardiac death in selected heart failure patients based on new evidence. ICDs and CRT are recommended for certain patient groups based on left ventricular ejection fraction, heart failure symptoms, and underlying heart disease or clinical history, as supported by clinical trial evidence. The guidelines also recommend regular assessment of ejection fraction for monitoring and treatment eligibility.
The 2005 ACC/AHA guidelines for diagnosis and management of chronic heart failure updated recommendations for use of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT). The guidelines recommend ICDs for primary prevention of sudden cardiac death in selected heart failure patients based on new evidence. ICDs and CRT are recommended for certain patient groups based on left ventricular ejection fraction, heart failure symptoms, and underlying heart disease or clinical history, as supported by major clinical trials. Ejection fraction measurement is recommended for initial evaluation and monitoring of heart failure patients.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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6. Classification of Heart Failure
ACCF/AHA Stages of HF NYHA Functional Classification
A At high risk for HF but without
structural heart disease or
symptoms of HF.
None
B Structural heart disease but
without signs or symptoms of HF.
I No limitation of physical activity. Ordinary
physical activity does not cause symptoms of HF.
C Structural heart disease with prior
or current symptoms of HF.
I No limitation of physical activity. Ordinary
physical activity does not cause symptoms of HF.
II Slight limitation of physical activity. Comfortable
at rest, but ordinary physical activity results in
symptoms of HF.
III Marked limitation of physical activity.
Comfortable at rest, but less than ordinary
activity causes symptoms of HF.
IV Unable to carry on any physical activity without
symptoms of HF, or symptoms of HF at rest.D Refractory HF requiring
specialized interventions.
7. A thorough history and physical examination should be
obtained/performed in patients presenting with HF to
identify cardiac and noncardiac disorders or behaviors
that might cause or accelerate the development or
progression of HF.
In patients with idiopathic DCM, a 3-generational family
history should be obtained to aid in establishing the
diagnosis of familial DCM.
Volume status and vital signs should be assessed at
each patient encounter. This includes serial assessment
of weight, as well as estimates of jugular venous
pressure and the presence of peripheral edema or
Orthopnea.
History and Physical Examination
I IIa IIb III
I IIa IIb III
I IIa IIb III
8. Diagnostic Tests
Initial laboratory evaluation of patients presenting with HF
should include complete blood count, urinalysis, serum
electrolytes (including calcium and magnesium), blood
urea nitrogen, serum creatinine, glucose, fasting lipid
profile, liver function tests, and thyroid-stimulating
hormone.
Serial monitoring, when indicated, should include serum
electrolytes and renal function.
A 12-lead ECG should be performed initially on all patients
presenting with HF.
I IIa IIb III
I IIa IIb III
I IIa IIb III
9. Recommendations for Noninvasive Imaging
Recommendation COR LOE
Patients with suspected, acute, or new-onset HF should undergo a
chest x-ray
I C
A 2-dimensional echocardiogram with Doppler should be
performed for initial evaluation of HF
I C
Repeat measurement of EF is useful in patients with HF who have
had a significant change in clinical status or received treatment
that might affect cardiac function, or for consideration of device
therapy
I C
Noninvasive imaging to detect myocardial ischemia and viability
is reasonable in HF and CAD
IIa C
Viability assessment is reasonable before revascularization in HF
patients with CAD
IIa B
Radionuclide ventriculography or MRI can be useful to assess
LVEF and volume
IIa C
MRI is reasonable when assessing myocardial infiltration or scar
IIa B
10. Recommendations for Invasive Evaluation
Recommendation COR LOE
Monitoring with a pulmonary artery catheter should be performed in
patients with respiratory distress or impaired systemic perfusion when
clinical assessment is inadequate
I C
When coronary ischemia may be contributing to HF, coronary
arteriography is reasonable
IIa C
Endomyocardial biopsy can be useful in patients with HF when a specific
diagnosis is suspected that would influence therapy
IIa C
11. Stage A
Hypertension and lipid disorders should be controlled in
accordance with contemporary guidelines to lower the risk
of HF.
Other conditions that may lead to or contribute to HF, such
as obesity, diabetes mellitus, tobacco use, and known
cardiotoxic agents, should be controlled or avoided.
I IIa IIb III
I IIa IIb III
12. Recommendations for Treatment of Stage B HF
Recommendations COR LOE
In patients with a history of MI and reduced EF, ACE
inhibitors or ARBs should be used to prevent HF I A
In patients with MI and reduced EF, evidence-based beta
blockers should be used to prevent HF I B
In patients with MI, statins should be used to prevent HF I A
Blood pressure should be controlled to prevent symptomatic
HF I A
ACE inhibitors should be used in all patients with a reduced
EF to prevent HF I A
Beta blockers should be used in all patients with a reduced EF
to prevent HF I C
An ICD is reasonable in patients with asymptomatic ischemic
cardiomyopathy who are at least 40 d post-MI, have an LVEF
≤30%, and on GDMT
IIa B
13. Stage C: Nonpharmacological
Interventions
Patients with HF should receive specific education to
facilitate HF self-care.
Exercise training (or regular physical activity) is
recommended as safe and effective for patients with HF
who are able to participate to improve functional status.
Sodium restriction is reasonable for patients with
symptomatic HF to reduce congestive symptoms.
I IIa IIb III
I IIa IIb III
I IIa IIb III
14. Pharmacological Therapy for Management
of Stage C HFrEF
Recommendations COR LOE
Diuretics
Diuretics are recommended in patients with HFrEF
with fluid retention I C
ACE Inhibitors
ACE inhibitors are recommended for all patients with
HFrEF I A
ARBs
ARBs are recommended in patients with HFrEF who
are ACE inhibitor intolerant I A
ARBs are reasonable as alternatives to ACE inhibitor
as first line therapy in HFrEF IIa A
15. Pharmacological Therapy for Management
of Stage C HFrEF (cont.)
Recommendations COR LOE
Beta Blockers
Use of 1 of the 3 beta blockers proven to reduce mortality is
recommended for all stable patients
I A
Aldosterone Antagonists
Aldosterone receptor antagonists are recommended in
patients with NYHA class II-IV HF who have LVEF ≤35%
I A
Aldosterone receptor antagonists are recommended in
patients following an acute MI who have LVEF ≤40% with
symptoms of HF or DM
I B
Hydralazine and Isosorbide Dinitrate
The combination of hydralazine and isosorbide dinitrate is
recommended for African-Americans, with NYHA class III–
IV HFrEF on GDMT
I A
A combination of hydralazine and isosorbide dinitrate can be
useful in patients with HFrEF who cannot be given ACE
inhibitors or ARBs
IIa B
16. Pharmacologic Therapy for Management
of Stage C HFrEF (cont.)
Recommendations COR LOE
Digoxin
Digoxin can be beneficial in patients with HFrEF IIa B
Anticoagulation
Patients with chronic HF with permanent/persistent/paroxysmal AF
and an additional risk factor for cardio embolic stroke should
receive chronic anticoagulant therapy*
I A
The selection of an anticoagulant agent should be individualized I C
Chronic anticoagulation is reasonable for patients with chronic HF
who have permanent/persistent/paroxysmal AF but without an
additional risk factor for cardio embolic stroke*
IIa B
Omega-3 Fatty Acids
Omega-3 PUFA supplementation is reasonable to use as adjunctive
therapy in HFrEF or HFpEF patients IIa B
17. Treatment of HFpEF
Recommendations COR LOE
Systolic and diastolic blood pressure should be
controlled according to published clinical practice
guidelines
I B
Diuretics should be used for relief of symptoms due
to volume overload I C
Coronary revascularization for patients with CAD
in whom angina or demonstrable myocardial
ischemia is present despite GDMT
IIa
C
Management of AF according to published clinical
practice guidelines for HFpEF to improve
symptomatic HF
IIa C
Use of beta-blocking agents, ACE inhibitors, and
ARBs for hypertension in HFpEF IIa C
18. Device Therapy for Stage C HFrEF
Recommendations COR LOE
ICD therapy is recommended for primary prevention of SCD in
selected patients with HFrEF at least 40 days post-MI with
LVEF ≤35%, and NYHA class II or III symptoms on
chronic GDMT, who are expected to live ≥1 year*
I A
CRT is indicated for patients who have LVEF ≤35%, sinus
rhythm, LBBB with a QRS ≥150 ms
I
A (NYHA
class
III/IV)
B (NYHA
class II)
ICD therapy is recommended for primary prevention of SCD in
selected patients with HFrEF at least 40 days post-MI with
LVEF ≤30%, and NYHA class I symptoms while
receiving GDMT, who are expected to live ≥1 year*
I B
19. Device Therapy for Stage C HFrEF (cont.)
Recommendations COR LOE
CRT can be useful for patients who have LVEF ≤35%, sinus
rhythm, a non-LBBB pattern with a QRS ≥150 ms, and NYHA
class III/ambulatory class IV symptoms on GDMT. IIa A
CRT can be useful for patients who have LVEF ≤35%, sinus
rhythm, LBBB with a QRS 120 to 149 ms, and NYHA class II, III
or ambulatory IV symptoms on GDMT
IIa
B
CRT can be useful in patients with AF and LVEF ≤35% on GDMT
if a) the patient requires ventricular pacing or otherwise meets CRT
criteria and b) AV nodal ablation or rate control allows near 100%
ventricular pacing with CRT IIa B
20. Water Restriction
Fluid restriction (1.5 to 2 L/d) is reasonable in
stage D, especially in patients with
hyponatremia, to reduce congestive symptoms.
I IIa IIb III
Management of stage A to D
21. Inotropic Support
Until definitive therapy (e.g., coronary revascularization,
MCS, heart transplantation) or resolution of the acute
precipitating problem, patients with cardiogenic shock
should receive temporary intravenous inotropic support to
maintain systemic perfusion and preserve end-organ
performance.
Continuous intravenous inotropic support is reasonable as
“bridge therapy” in patients with stage D refractory to
GDMT and device therapy who are eligible for and
awaiting MCS or cardiac transplantation.
I IIa IIb III
I IIa IIb III
22. Mechanical Circulatory Support
MCS use is beneficial in carefully selected* patients with
stage D HFrEF in whom definitive management (e.g.,
cardiac transplantation) or cardiac recovery is anticipated
or planned.
Nondurable MCS, including the use of percutaneous and
extracorporeal ventricular assist devices (VADs), is
reasonable as a “bridge to recovery” or a “bridge to
decision” for carefully selected* patients with HFrEF with
acute, profound hemodynamic compromise.
Durable MCS is reasonable to prolong survival for carefully
selected* patients with stage D HFrEF.
I IIa IIb III
I IIa IIb III
I IIa IIb III
23. Surgical/Percutaneous/Trans catheter
Interventional Treatment of HF
Recommendation COR LOE
CABG or percutaneous intervention is indicated for HF patients on
GDMT with angina and suitable coronary anatomy especially, significant
left main stenosis or left main equivalent disease
I C
CABG to improve survival is reasonable in patients with mild to
moderate LV systolic dysfunction and significant multivessel CAD or
proximal LAD stenosis when viable myocardium is present
IIa B
CABG or medical therapy is reasonable to improve morbidity and
mortality for patients with severe LV dysfunction (EF <35%), HF and
significant CAD
IIa B
Surgical aortic valve replacement is reasonable for patients with critical
aortic stenosis and a predicted surgical mortality of no greater than 10%
IIa B
Trans catheter aortic valve replacement is reasonable for patients with
critical aortic stenosis who are deemed inoperable
IIa B
24. Surgical/Percutaneous/Trans catheter
Interventional Treatment of HF
Recommendation COR LOE
CABG may be considered in patients with ischemic heart
disease, severe LV systolic dysfunction and suitable coronary
anatomy whether or not viable myocardium is present
IIb B
Trans catheter mitral valve repair or mitral valve surgery for
functional mitral insufficiency is of uncertain benefit
IIb B
Surgical reverse remodeling or LV aneurysmectomy may be
considered in HFrEF for specific indications including
intractable HF and ventricular arrhythmias
IIb B
25. Cardiac Transplantation
Evaluation for cardiac transplantation is indicated
for carefully selected patients with stage D HF
despite GDMT, device, and surgical
management.
I IIa IIb III
28. Theory
• Systolic HF leads to an enlarged LV volume to
maintain stroke volume
• This leads to increase in wall stress due to
Laplace's law
stress = pressure x radius ÷ 2 x wall thickness
• The ventricular geometry becomes less ellipsoid
and more spherical leading to progression of left
ventricular dysfunction and worsening heart
failure.
29. • Removing or excluding portions of the
dysfunctional myocardium returns the left
ventricular cavity to a smaller chamber with
more normal geometry
• This should improve cardiac work efficiency and
theoretically should improve heart failure
symptoms.
30. • Reducing the LV size
– The Batista operation
– Left ventricular aneurysmectomy
– Ventricular restraint devices
31. • Reduction left ventriculo plasty
• Developed by Dr. Randas Batista (Brazil) in
1996
Batista Procedure
32.
33. Dor Procedure
• Endoventricular circular patch plasty (EVCPP)
• Surgical reconstruction in the setting of post
infarction aneurysm formation first reported in
1985
34. Considered Criteria for Surgical Repair
• Previous Anterior MI,
• Dilated left ventricle (end-diastolic volume index
>100 mL/m2)
• Depressed LVEF
• Left ventricular regional dyskinesis or akinesis
>30 percent of the ventricular perimeter
• Symptoms of HF
35. Contraindications
• Systolic pulmonary artery pressure >60 mmHg
• Severe right ventricular dysfunction
• Regional dyskinesis or akinesis without dilation
of the ventricle