Heart Failure: Difference between revisions

Jump to navigation Jump to search

Heart Failure (view source)

Revision as of 14:40, 19 January 2012

1,580 bytes removed ,  19 January 2012
→‎Heart catheterization
Line 210: Line 210:


===== Heart catheterization =====
===== Heart catheterization =====
Heart catheterization is not part of the routine diagnosis and work-up of patients with HF.  But in patients suffering angina pectoris despite optimal medical therapy, it should be considered (Class of recommendation IIa, level of evidence C, see table 4). Also, coronary angiography is recommended in patients at high risk of coronary artery disease  (Class of recommendation I, level of evidence C) and in HF patients with significant valvular disease (Class of recommendation IIa, level of evidence C).
Heart catheterization is not part of the routine diagnosis and work-up of patients with HF.  But in patients suffering angina pectoris despite optimal medical therapy, it should be considered (Class of recommendation IIa, level of evidence C, see Table 4). Also, coronary angiography is recommended in patients at high risk of coronary artery disease  (Class of recommendation I, level of evidence C) and in HF patients with significant valvular disease (Class of recommendation IIa, level of evidence C).
 
Table 3 Common echocardiographic abnormalities in heart failure
Measurement Abnormality Clinical implications
LVEF Reduced (<45 – 50%) Systolic dysfunction
LV ejection fraction Akinesis, hypokinesis, dyskinesis Myocardial infarction/ischaemia, cardiomyopathy, myocarditis
End-diastolic diameter Increased (>55 – 60 mm) Volume overload
HF likely
End-systolic diameter Increased (>45 mm) Volume overload
HF likely
Fractional shortening Reduced (<25%) Systolic dysfunction
Left atrial size Increased (>40 mm) Increased filling pressures, mitral valve dysfunction, atrial fibrillation
Left ventricular thickness Hypertrophy (>11 – 12 mm) Hypertention, aortic stenosis, hypertrophic cardiomyopathy
Valvular structure and function Valvular stenosis or regurgitation (especially aortic stenosis and mitral insufficiency) May be primary cause of HF or complicating factor
Asses haemodynamic consequences
Consider surgery
Mitral diastolic flow profile Abnormalities of the early and late diastolic filling patterns Indicates diastolic dysfunction and suggests mechanism
Tricuspid regurgitation peak velocity Increased (>3 m/s) Increased right ventricular systolic pressure
Suspect pulmonary hypertention
Pericardium Effusion, haemopericardium, thickening Consider tamponade, uraemia, malignancy, systemic disease, acute or chronic pericarditis, contrictive pericarditis
Aortic outflow velocity time integral Reduced (<15 cm) Reduced low stroke volume
Inferior vena cava Dilated retrograde flow Increased right atrial pressures, right ventricular dysfunction, hepatic congestion


== Management ==
== Management ==
Nja
401

edits

Retrieved from "https://www.textbookofcardiology.org/wiki/Special:MobileDiff/721"

Navigation menu