Congestive heart failure

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Resident
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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

Congestive heart failure On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Congestive heart failure

CDC on Congestive heart failure

Congestive heart failure in the news

Blogs on Congestive heart failure

Directions to Hospitals Treating Congestive heart failure

Risk calculators and risk factors for Congestive heart failure

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2], Mitra Chitsazan, M.D.[3] Seyedmahdi Pahlavani, M.D. [4] Syed Hassan A. Kazmi BSc, MD [5] Edzel Lorraine Co, D.M.D., M.D. [6]

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

Overview

Classification

Pathophysiology

Systolic dysfunction | Diastolic dysfunction | HFpEF | HFrEF

Causes

Differentiating Chronic Heart Failure from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

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:

Guideline-recommended medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) can be suggested by the Heart Failure Educational Decision Aid medication optimization algorithm[1].

Cardiac rhythm management for patients with heart failure with reduced ejection fraction: Antiarrhythmic drugs | Implantable cardioverter defibrillator | Cardiac resynchronization therapy
Nutritional supplements and hormonal therapies
Exercise training
Drugs to avoid
Drug interactions
Treatment of underlying causes
Treatment of associated conditions

Treatment of Heart failure with preserved ejection fraction

Management of Acute heart failure

Management of Advanced heart failure

Ultrafiltration | Mechanical circulatory support | Heart transplantation

ACC/AHA Guideline Recommendations

Hospitalized Patients

Patients With a Prior MI

Sudden Cardiac Death Prevention

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

Stage B: Patients with Cardiac Structural Abnormalities

Stage C: Patients with Current or Prior Heart Failure Symptoms

Stage D: Patients with Refractory End-stage Heart Failure

Implementation of Practice Guidelines

End-Of-Life Considerations

Specific Groups

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

References

  1. Dorsch, Michael P.; Sifuentes, Aaron; Cordwin, David J.; Kuo, Rachel; Rowell, Brigid E.; Arzac, Juan J.; DeBacker, Ken; Guidi, Jessica L.; Hummel, Scott L.; Koelling, Todd M. (April 2023). "A Computable Algorithm for Medication Optimization in Heart Failure With Reduced Ejection Fraction". JACC: Advances: 100289. doi:10.1016/j.jacadv.2023.100289. ISSN 2772-963X.

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