Congestive heart failure with preserved EF

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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

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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 with preserved EF On the Web

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FDA on Congestive heart failure with preserved EF

CDC on Congestive heart failure with preserved EF

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Directions to Hospitals Treating Congestive heart failure with preserved EF

Risk calculators and risk factors for Congestive heart failure with preserved EF

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Pathophysiology

  • Ventricular diastolic dysfunction is the main stay in developing heart failure with preserved EF (HFpEF). Patients with HFpEF have more impaired LV relaxation and diastolic stiffness compared to healthy or hypertensive controls without HF.[1][2]

Other contributing factors include:

  • LV hypertrophy

LV mass is higher in patients with HFpEF comparing to healthy people or hypertensive patients.[3]

References

  1. Borlaug BA, Jaber WA, Ommen SR, Lam CS, Redfield MM, Nishimura RA (2011). "Diastolic relaxation and compliance reserve during dynamic exercise in heart failure with preserved ejection fraction". Heart. 97 (12): 964–9. doi:10.1136/hrt.2010.212787. PMC 3767403. PMID 21478380.
  2. Lam CS, Roger VL, Rodeheffer RJ, Bursi F, Borlaug BA, Ommen SR, Kass DA, Redfield MM (2007). "Cardiac structure and ventricular-vascular function in persons with heart failure and preserved ejection fraction from Olmsted County, Minnesota". Circulation. 115 (15): 1982–90. doi:10.1161/CIRCULATIONAHA.106.659763. PMC 2001291. PMID 17404159.
  3. Mohammed SF, Borlaug BA, Roger VL, Mirzoyev SA, Rodeheffer RJ, Chirinos JA, Redfield MM (2012). "Comorbidity and ventricular and vascular structure and function in heart failure with preserved ejection fraction: a community-based study". Circ Heart Fail. 5 (6): 710–9. doi:10.1161/CIRCHEARTFAILURE.112.968594. PMC 3767407. PMID 23076838.


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