Congestive heart failure and exercise

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Congestive Heart Failure Microchapters

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Patient Information

Overview

Historical Perspective

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Pathophysiology

Systolic Dysfunction
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HFpEF
HFrEF

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Differentiating Congestive heart failure from other Diseases

Epidemiology and Demographics

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Diagnosis

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Exercise Stress Test

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Treatment

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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

Congestive heart failure and exercise On the Web

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Risk calculators and risk factors for Congestive heart failure and exercise

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]; Arzu Kalayci, M.D. [3]

Overview

  • Patient should have uninterrupted exercise at least four days a week including a walking program.
  • Patients with heart failure should avoid weightlifting which increases afterload.
  • The patient should not routinely lift more than 20 pounds, again which may increase afterload.
  • Patients can continue their sexual activity. 2.5 or 5.0 mg of sublingual nitroglycerine can be taken before sexual activity to improve exercise capacity.

Contributory risk and Management of Comorbidities of Hypertension, obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association (2016)

Initial Clinical Assessment of Patients Presenting With Heart Failure (DO NOT EDIT) [1][2]

Class I
"1. In patients presenting with heart failure, initial assessment should be made of the patient’s ability to perform routine and desired activities of daily living. (Level of Evidence: C)"

Serial Clinical Assessment of Patients Presenting With Heart Failure (DO NOT EDIT) [1][2]

Class I
"1. Assessment should be made at each visit of the ability of a patient with heart failure to perform routine and desired activities of daily living. (Level of Evidence: C)"

Exercise training in Patients Presenting With Heart Failure (DO NOT EDIT) [1][2]

Class I

1. Exercise or regular physical activity is beneficial in prevention of CVD and HF. (Class I, Level of Evidence: B)

2. 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. (Class I, Level of Evidence: A)

Class IIa
"1. Maximal exercise testing with or without measurement of respiratory gas exchange is reasonable to facilitate prescription of an appropriate exercise program for patients presenting with heart failure. (Level of Evidence: C)"

Vote on and Suggest Revisions to the Current Guidelines

Guidelines Resources

References

  1. 1.0 1.1 1.2 1.3 Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202
  2. 2.0 2.1 2.2 2.3 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 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. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967



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