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Heart Failure: Difference between revisions
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| '''Measurement''' | | '''Measurement''' | ||
| '''Abnormality''' | | width="400px"|'''Abnormality''' | ||
| '''Clinical implications''' | | '''Clinical implications''' | ||
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|- | |- | ||
| LV ejection fraction | | LV ejection fraction | ||
| Akinesis | | | ||
| Myocardial infarction/ischaemia | *Akinesis | ||
*Hypokinesis | |||
*Dyskinesis | |||
| | |||
*Myocardial infarction/ischaemia | |||
*Cardiomyopathy | |||
*Myocarditis | |||
|- | |- | ||
| End-diastolic diameter | | End-diastolic diameter | ||
| Increased (>55 – 60 mm) | | Increased (>55 – 60 mm) | ||
| Volume overload | | | ||
HF likely | *Volume overload | ||
*HF likely | |||
|- | |- | ||
| End-systolic diameter | | End-systolic diameter | ||
| Increased (>45 mm) | | Increased (>45 mm) | ||
| Volume overload | | | ||
HF likely | *Volume overload | ||
*HF likely | |||
|- | |- | ||
| Fractional shortening | | Fractional shortening | ||
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| Left atrial size | | Left atrial size | ||
| Increased (>40 mm) | | Increased (>40 mm) | ||
| Increased filling pressures | | | ||
*Increased filling pressures | |||
*Mitral valve dysfunction | |||
*Atrial fibrillation | |||
|- | |- | ||
| Left ventricular thickness | | Left ventricular thickness | ||
| Hypertrophy (>11 – 12 mm) | | Hypertrophy (>11 – 12 mm) | ||
| Hypertention | | | ||
*Hypertention | |||
*Aortic stenosis | |||
*Hypertrophic cardiomyopathy | |||
|- | |- | ||
| Valvular structure and function | | Valvular structure and function | ||
| Valvular stenosis or regurgitation (especially aortic stenosis and mitral insufficiency) | | Valvular stenosis or regurgitation (especially aortic stenosis and mitral insufficiency) | ||
| May be primary cause of HF or complicating factor | | | ||
Asses haemodynamic consequences | *May be primary cause of HF or complicating factor | ||
Consider surgery | *Asses haemodynamic consequences | ||
*Consider surgery | |||
|- | |- | ||
| Mitral diastolic flow profile | | Mitral diastolic flow profile | ||
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| Tricuspid regurgitation peak velocity | | Tricuspid regurgitation peak velocity | ||
| Increased (>3 m/s) | | Increased (>3 m/s) | ||
| Increased right ventricular systolic pressure | | | ||
Suspect pulmonary hypertention | *Increased right ventricular systolic pressure | ||
*Suspect pulmonary hypertention | |||
|- | |- | ||
| Pericardium | | Pericardium | ||
| Effusion | | | ||
| Consider tamponade | *Effusion | ||
*Haemopericardium | |||
*Thickening | |||
| | |||
*Consider tamponade | |||
*Uraemia | |||
*Malignancy | |||
*Systemic disease | |||
*Acute or chronic pericarditis | |||
*Contrictive pericarditis | |||
|- | |- | ||
| Aortic outflow velocity time integral | | Aortic outflow velocity time integral | ||
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| Inferior vena caval | | Inferior vena caval | ||
| Dilated retrograde flow | | Dilated retrograde flow | ||
| Increased right atrial pressures | | | ||
*Increased right atrial pressures | |||
*Right ventricular dysfunction | |||
*Hepatic congestion | |||
|} | |} | ||
</div> | </div> | ||
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===== Alcohol and tobacco ===== | ===== Alcohol and tobacco ===== | ||
Alcohol intake should be minimized, as it may increase blood pressure and/or have a negative inotropic effect. (Class | Alcohol intake should be minimized, as it may increase blood pressure and/or have a negative inotropic effect. (Class II a recommendation, level of evidence C) Smoking cessation should be encouraged. It is recommended that patients with HF receive support and advice on this topic. (Class I recommendation, level of evidence C). A reduction in alcohol and tobacco intake might also improve co-morbidities including sleep disorders. | ||
===== Exercise ===== | ===== Exercise ===== | ||
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Possible side effects include symptomatic hypotension or drug-induced lupus-like syndrome. | Possible side effects include symptomatic hypotension or drug-induced lupus-like syndrome. | ||
==== Other ==== | ==== Other ==== | ||
Anticoagulants | *Anticoagulants | ||
*Anti platelet agents | |||
*Statins | |||
*Anti arrhythmic medication | |||
*Calcium antagonists | |||
=== Management of HF patients with preserved LVEF (HFPEF) === | === Management of HF patients with preserved LVEF (HFPEF) === | ||
To date, no evidence exists of any treatment reducing morbidity or mortality in this patient group. With the aim to control water and sodium retention and decrease breathlessness and edema, diuretics are prescribed to HFPEF patients. | To date, no evidence exists of any treatment reducing morbidity or mortality in this patient group. With the aim to control water and sodium retention and decrease breathlessness and edema, diuretics are prescribed to HFPEF patients. | ||
{| class="wikitable" border="1" | |||
<div align="center"> | |||
{| class="wikitable" border="1" width="90%" cellpading="2" cellspacing="2" | |||
|- | |- | ||
| colspan="6" | '''Table 4''' | |colspan="6" align="center" bgcolor="#E3E4FA"|'''Table 4''' | ||
|- | |- | ||
| colspan="6 | | colspan="6"| '''Size of treatment effect''' | ||
|- | |- | ||
| rowspan="6" width=" | | rowspan="6" width="50px"| '''Estimate of Certainty (precision) of treatment effect''' | ||
| | |||
| valign="top | |||valign="top"|'''Class I''' | ||
Benefit >>> Risk | Benefit >>> Risk | ||
| valign="top | |||
|valign="top"|'''Class IIa''' | |||
Benefit >> Risk | Benefit >> Risk | ||
Additional studies with focused objectives needed | Additional studies with focused objectives needed | ||
| valign="top | |||
|valign="top"|'''Class IIb''' | |||
Benefit ≥ Risk''' | Benefit ≥ Risk''' | ||
Additional studies with broad objectives needed; additional registry data would be helpful | Additional studies with broad objectives needed; additional registry data would be helpful | ||
| valign="top | |||
|valign="top"|'''Class III''' | |||
Benefit ≥ Risk | Benefit ≥ Risk | ||
No additional studies needed | No additional studies needed | ||
|- | |- | ||
| | |||Procedure/treatment should be performed/administered | ||
| It is reasonable to perform/administer treatment | |||
| Procedure/treatment may be considered | |||
| Procedure/treatment should not be performed/administered since it is not helpful and may be harmful | |||
|- | |- | ||
| '''Level A''' | |||
Multiple (3-5) population risk strata evaluated | |||
| Recommendation that procedure or treatment is useful/effective | |||
Sufficient evidence from multiple randomized trials or non-randomized trials | |||
| Recommendation in favor of treatment or procedure being useful/effective | |||
Some conflicting evidence from multiple randomized trials or meta-analyses | |||
| Recommendation’s usefulness/efficacy less well established | |||
| | |||
Greater conflicting evidence from multiple randomized trials or meta-analyses | |||
| Recommendation that procedure or treatment not useful/effective and may be harmful | |||
| | |||
Sufficient evidence from multiple randomized trials or meta-analyses | |||
|- | |- | ||
| '''Level B''' | |||
Limited (2-3) population risk strata evaluated | |||
| Recommendation that procedure or treatment is useful/effective | |||
Limited | Limited evidence from single randomized trial or non-randomized studies | ||
| | |||
| Recommendation in favor of treatment or procedure being useful/effective | |||
Some conflicting evidence from single randomized trial or non-randomized studies | |||
| Recommendation’s usefulness/efficacy less well established | |||
| | |||
Greater conflicting evidence from single randomized trial or non-randomized studies | |||
| Recommendation that procedure or treatment not useful/effective and may be harmful | |||
| | |||
Limited evidence from single randomized trial or non-randomized studies | |||
|- | |- | ||
| '''Level C''' | |||
Very limited (1-2) population risk strata evaluated | |||
| Recommendation that procedure or treatment is useful/effective | |||
Only experts opinion, case studies, or standard-of-care | |||
| Recommendation in favor of treatment or procedure being useful/effective | |||
| | |||
Only diverging expert opinion case studies, or standard-of-care | |||
| Recommendation’s usefulness/efficacy less well established | |||
| | |||
Only diverging expert opinion case studies, or standard-of-care | |||
| Recommendation that procedure or treatment not useful/effective and may be harmful | |||
| | |||
Only expert opinion case studies, or standard-of-care | |||
|} | |} | ||
</div> | |||
{{clr}} | {{clr}} | ||