Heart Failure: A Case-Based Approach

✍ Scribed by Peter S. Rahko (editor)

• Publisher: Demos Medical
• Year: 2013
• Tongue: English
• Leaves: 278
• Category: Library

✦ Table of Contents

Cover
Title Page
Copyright Page
Contents
Contributors
Preface
Video Captions
Part I: Newly Diagnosed Heart Failure
1. Initial Presentation of Heart Failure: The Non-Ischemic Dilated Cardiomyopathy
Case Presentation
Symptoms and Signs of Heart Failure
ECG, Chest X-Ray, Laboratory Exam
Natriuretic Peptide Biomarkers
Echocardiography
Evaluation for Coron Aryartery Disease
Medical Treatment of Heart Failure
Conclusion
References
2. Patient with Heart Failure Following a Large Myocardial Infarction
Case Presentation
Post-Myocardial Infarction Care
Risk Stratification
Comorbidities
Social Determinants in Heart Failure
Potential for Cardiac Function Recovery
Device Therapies for Heart Failure
References
3. Tako-Tsubo (Stress) Cardiomyopathy
Case Presentation
Approach to the Patient
Imaging
Hospital Management
Congestive Heart Failure
Ventricular Thrombus
Arrhythmia and ECG Evolution
Posthospital Management
Bibliography
4. Atrial Fibrillation and Cardiomyopathy with Heart Failure
Introduction
Case 1: Atrial Fibrillation as a Result of Patient Noncompliance
Case 2: Atrial Fibrillation Causing Tachycardia-Mediated Cardiomyopathy
Case 3: Atrial Fibrillation Complicating Infiltrative Cardiomyopathy with Preserved Left Ventricular Ejection Fraction—Amyloidosis
Summary
References
5. Heart Failure with Preserved Ejection Fraction (HFPEF): A Common Sense Approach
Introduction
HFPEF Epidemiology
Pathophysiology
Nomenclature
Normal Diastole Physiology
Abnormalities of Diastole with HFPEF
Case Presentation
Definition and Diagnosis of HFPEF
Case Continuation
Physiological Consideration of HFPEF
Acute Presentation, Evaluation, and Management of HFPEF
Current Diagnostic Criteria for HFPEF
Doppler Echocardiography and HFPEF
Hospital to Home Challenges in HFPEF
Beyond Hospital to Home Transitions in Care
Targeted Therapies for HFPEF
Emerging Therapies for HFPEF
Conclusion
References
Part II: Optimizing Therapy for Patients with Chronic Heart Failure
6. Acute Decompensated Heart Failure in the Previously Stable Heart Failure Patient: A Practical Guide to Evaluation and Treatment
Case Presentation
Acute Decompensated Heart Failure
Determining the Etiology
Optimal Treatment
Preventing Readmission
References
7. Optimizing Heart Failure Management in Idiopathic Non-Ischemic Dilated Cardiomyopathy Complicated by Ventricular Arrhythmia
The Clinical Problem
Case Highlights
Problem of QRS Widening in the Heart Failure Patient
Role of Cardiac Resynchronization
Syncope in NIDCM
Prevention of Sudden Cardiac Death in NIDCM
Management of Recurrent Ventricular Arrhythmias in NIDCM
Summary
References
8. Cardiac Resynchronization Therapy in Heart Failure
Introduction
Background
Mechanisms
Clinical Trial Data in Moderate Severe Heart Failure
Clinical Trial Data in Mild to Moderate Heart Failure
Major Society Guidelines
Return to Case Presentations
References
9. Hemodynamic Optimization in the Patient with Refractory Systolic Heart Failure
Case Presentation
References
Part III: Heart Failure with Multiple Treatment Issues
10. Evaluation and Management of the Heart Transplant Candidate
Background
Evaluation for Ventricular Assist Device and Cardiac Transplant Candidacy
Cardiopulmonary Stress Testing
Pulmonary Hypertension
Physical Factors
Other Systemic Disease
Tobacco Use
Psychological Factors
Health Maintenance
Histocompatibility Testing
Bridging to Cardiac Transplantation with a Ventricular Assist Device
References
11. Low Gradient Aortic Stenosis and Significant Left Ventricular Dysfunction
Introduction
CASE PRESENTATION
Clinical Presentation of Severe as with Left Ventricular Dysfunction
Diagnosis of Low-Gradient as
Low-Dose Dobutamine Stress Testing
Figure 11-5Diagram of the dobutamine stress protocol for evaluation of low-output, low-gradient aortic stenosis (AS). The dobutamine dose is increasedevery 3 to 5 minutes with Doppler-echo data recording (as shown in the bars at the top of the fi gure) and patient monitoring (as shown in thebars along the bottom). AS-jet, aortic stenosis maximum velocity recorded with continuous wave Doppler; biplane LV, biplane images forcalculation of left ventricular ejection fraction.
Figure 11-4Flow chart for suggested approach to identifi cation, evaluation, and surgical candidacy for low-gradient aortic stenosis (AS). An aortic valvearea (AVA) <1.0 cm2 and the presence of a peak velocity (Vmax) less than 4 m/s or mean gradient (ΔPmean) <40 mmHg identifi es those with lowgradient AS. Those with a small AVA and Vmax >4 m/s or ΔPmean >40 mmHg have severe AS regardless of LV ejection fraction (EF). Dobutaminestress echocardiography is a reasonable approach when velocity is lower than expected for valve area in order to assess the change in Vmax andAVA with changes in transaortic stroke volume (SV). Those who have pseudosevere AS require further observation for progression to severestenosis but do not require aortic valve replacement (AVR) at this time. Those with severe AS and contractile reserve should undergo AVR. Inthose without contractile reserve, AS severity is indeterminate; however, selected patients may benefi t from high-risk AVR.
CASE PRESENTATION
Figure 11-6Cardiovascular death among patients with preserved LVEF andLGAS, moderate AS, and severe AS. Patients with preserved EF andLGAS have similar outcomes to those with moderate AS, while thosewith severe AS have markedly worse outcome.Note: AS = aortic stenosis; LVEF = left venricular ejection fraction; LGAS = lowgradient aortic stenosis.
Low Gradient as with Preserved Ejection Fraction
Medical Options and Palliation
Selection for Aortic Valve Surgery
Figure 11-7Survival from identifi cation of low gradient aortic stenosis (AS) byecho or following aortic valve replacement (AVR) among patients withor without contractile reserve. Survival following AVR was improvedfor those receiving AVR within groups with or without contractilereserve relative to those not selected for AVR.
Catheter-Based Options in LGAS
Conclusions
References
12. Left Ventricular Dysfunction with Mitral Regurgitation
Case Presentation
Background
Mitral Valve Anatomy
Left Ventricular Dysfunction in Patients with MR Due to Primary Valvular Etiology
FMR Secondary to Left Ventricular Dysfunction
MR Due to Active Myocardial Ischemia
Nonsurgical Management of MR with Associated Left Ventricular Dysfunction
Surgery in Patients with MR and Left Ventricular Dysfunction
Emerging Minimally Invasive and Transcatheter Options to Treat MR
Follow-up of Patients with MR Receiving Surgery, Transcatheter Interventions, or Medical Treatment
References
Resources
13. Symptomatic Obstructive Hypertrophic Cardiomyopathy
Introduction
Clinical Symptoms and Physical Signs
Two-Dimensional and Doppler Echocardiography
Invasive Cardiac Catheterization
General Management Guidelines
Medical Therapy
Septal Reduction Therapy
Nonobstructive HCM
Risk Stratification for Sudden Cardiac Death
Conclusion and Key Points
References
Part IV: Heart Failure Associated with other Systemic Disease
14. Heart Failure in Patients with Chronic Obstructive Pulmonary Disease
Case Presentation
Clinical Evaluation
Therapy
Maintenance Therapy
Beta-Blockade
Pulmonary Therapy
Therapy for Acute Exacerbations
Summary
References
15. Cardiotoxicity of Anticancer Treatment
Introduction
CASE PRESENTATION: PART 1
Anthracycline Cardiomyopathy
Cardiac Ischemia
CASE PRESENTATION: PART 3
Hypertension
Thromboembolic Disease
Arrhythmia
Radiation Heart Disease
Metastatic Disease and the Heart
Summary
References
16. Cardiac Amyloidosis
Case Presentation
History and Physical Exam
Electrocardiogram and Echocardiogram
Cardiac CT and Cardiac Magnetic Resonance
Hemodynamics
Classification of Amyloid Heart Disease
Biomarkers
Diagnosis and Treatment of AL Amyloidosis
Treatment Options
Treatment of End-Stage Heart Failure
References
17. Left Ventricular Dysfunction and Associated Renal Failure: The Cardiorenal Syndrome
Introduction
CASE PRESENTATION
Diuretic Therapy
CASE PRESENTATION
CASE PRESENTATION
Figure 17-1Mechanisms of diuretics. Positive and negative physiologic effects of loop diuretics as well as sites of action for thiazide diuretics andaldosterone antagonists.Note: CHF = congestive heart failure; LV = left ventricular; MR = mitral regurgitation; RAAS = renin–angiotensin–aldosterone system.
Nesiritide Therapy
CASE PRESENTATION CASE PRESENTATION
Milrinone Therapy
CASE PRESENTATION CASE PRESENTATION
Dobutamine/Dopamine Therapy
CASE PRESENTATION
Importance of Increased IAP on Renal Function
CASE PRESENTATION
ACE Inhibitors, Thiazide Diuretics, and Carbonic Anhydrase Inhibitors
Importance of CVP on Renal Function
Ultrafiltration
Conclusion
References
Part V: Special Topics in heart Failure
18. Evaluation and Workup of a Patient with Familial Dilated Cardiomyopathy
Introduction
Background
Patient Evaluation
Family History
Treatment and Management of Patients with Genetic DCM
Current State of Genetic Testing for FDC
Conclusion
References
19. The Role of Risk Modeling in Heart Failure
Case Presentation
Predicting Survival
The Seattle Heart Failure Model
Advanced Heart Failure Prognosis
Heart Failure Scoring Systems
References
Index