Congestive heart failure treatment of patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B): Difference between revisions
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===Class III=== | ===Class III=== | ||
}} | 1. [[Digoxin]] should not be used in patients with low [[EF]], [[sinus rhythm]], and no history of [[HF]] symptoms, because in this population, the risk of harm is not balanced by any known benefit. ''(Level of Evidence: C)'' | ||
2. Use of [[nutritional supplements]] to treat structural [[heart disease]] or to prevent the development of symptoms of [[HF]] is not recommended. ''(Level of Evidence: C)'' | |||
3. [[Calcium channel blockers]] with negative inotropic effects may be harmful in asymptomatic patients with low [[LVEF]] and no symptoms of [[HF]] after [[MI]] (Patients in Stage C). ''(Level of Evidence: C)''}} | |||
==See Also== | ==See Also== | ||
Revision as of 13:52, 10 June 2009
| Heart failure | |
| ICD-10 | I50.0 |
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| ICD-9 | 428.0 |
| DiseasesDB | 16209 |
| MedlinePlus | 000158 |
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| MeSH | D006333 |
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Overview of Treatment of Patients With Cardiac Structural Abnormalities or Remodeling who have not Developed Heart Failure Symptoms (Stage B)
ACC / AHA Guidelines- Treatment of Patients With Cardiac Structural Abnormalities or Remodeling who have not Developed Heart Failure Symptoms (Stage B) (DO NOT EDIT) [1]
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Class I1. All Class I recommendations for Stage A should apply to patients with cardiac structural abnormalities who have not developed HF. (Levels of Evidence: A, B, and C as appropriate) 2. Beta-blockers and ACEIs should be used in all patients with a recent or remote history of MI regardless of EF or presence of HF. (Level of Evidence: A) 3. Beta-blockers are indicated in all patients without a history of MI who have a reduced LVEF with no HF symptoms. (Level of Evidence: C) 4. Angiotensin converting enzyme inhibitors should be used in patients with a reduced EF and no symptoms of HF, even if they have not experienced MI. (Level of Evidence: A) 5. An ARB should be administered to post-MI patients without HF who are intolerant of ACEIs and have a low LVEF. (Level of Evidence: B) 6. Patients who have not developed HF symptoms should be treated according to contemporary guidelines after an acute MI. (Level of Evidence: C) 7. Coronary revascularization should be recommended in appropriate patients without symptoms of HF in accordance with contemporary guidelines (see ACC/AHA Guidelines for the Management of Patients With Chronic Stable Angina). (Level of Evidence: A) 8. Valve replacement or repair should be recommended for patients with hemodynamically significant valvular stenosis or regurgitation and no symptoms of HF in accordance with contemporary guidelines. (Level of Evidence: B) Class IIa1. Angiotensin converting enzyme inhibitors or ARBs can be beneficial in patients with hypertension and LVH and no symptoms of HF. (Level of Evidence B) 2. Angiotensin II receptor blockers can be beneficial in patients with low EF and no symptoms of HF who are intolerant of ACEIs. (Level of Evidence: C) 3. Placement of an ICD is reasonable in patients with ischemic cardiomyopathy who are at least 40 days post-MI, have an LVEF of 30% or less, are NYHA functional class I on chronic optimal medical therapy, and have reasonable expectation of survival with a good functional status for more than 1 year. (Level of Evidence: B) Class IIb1. Placement of an ICD might be considered in patients without HF who have nonischemic cardiomyopathy and an LVEF less than or equal to 30% who are in NYHA functional class I with chronic optimal medical therapy and have a reasonable expectation of survival with good functional status for more than 1 year. (Level of Evidence: C) Class III1. Digoxin should not be used in patients with low EF, sinus rhythm, and no history of HF symptoms, because in this population, the risk of harm is not balanced by any known benefit. (Level of Evidence: C) 2. Use of nutritional supplements to treat structural heart disease or to prevent the development of symptoms of HF is not recommended. (Level of Evidence: C) 3. Calcium channel blockers with negative inotropic effects may be harmful in asymptomatic patients with low LVEF and no symptoms of HF after MI (Patients in Stage C). (Level of Evidence: C) |
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See Also
Sources
- The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult [1]
References
- ↑ 1.0 1.1 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