Escolar Documentos
Profissional Documentos
Cultura Documentos
Age
Male
HTN/LVH
CAD/MI
Valvular heart disease
Obeisity
DM
Minor Risk Factors
Smoking
Hyperlipidemia
CKI
Albumimuria
OSA
Anemia
Tachycardia
CHF 2018 Update
Immune-mediated
Peripartum cardiomyopathy, hypersensitivity
Infectious
Viral, parasitic (Chagas disease), bacterial
Toxic risk precipitants
Chemotherapy (anthracyclines,
cyclophosphamide, 5-FU), targeted cancer
therapy (trastuzumab, tyrosine kinase inhibitors),
cocaine, NSAIDs, thiazolidinediones, doxazosin,
alcohoSNP (e.g. α2CDel322-325, β1Arg389),
family history, congenital heart
CHF Update 2018
Reduced Contractility------> decreased CO
Increased preload/LAP
Increased HR ( CO=HR x SV )
CHF Update 2018
CHF Update 2018
CHF Update 2018
CHF Update 2018
BNP
32 amino acid peptide (134 AA NT-pro BNP)
ACC/AHA Classification
– Class A
– Class B
– Class C
– Class D
CHF Update 2018
Stage A
Asymptomatic but with significant risk
Rx of lipids/DM
Stage B
Stage C
Symptomatic with signs/symptoms of CHF
Standard Rx
Aldosterone antagonists
Nitrates/hydralazine
CHF Update 2018
Stage D
Continued standard Rx
Transplant
Resynchronization therapy
LVAD
Inotropic Rx
CHF Update 2018
NYHA Classification
Class I asymptomatic
Class II symptoms with significant activity
Class III symptoms with minimal activity
Class IV symptoms at rest
CHF Update 2018
CBC
UA
CMP
Fasting blood glucose levels
Lipid profile
Thyroid stimulating hormone (TSH) levels
B-type natriuretic peptide levels/pro BNP N-terminal
natriuretic peptide levels
Electrocardiography
CHF Update 2018
Electrocardiography
Chest radiography
Two-dimensional (2-D) echocardiography
Nuclear imaging
Maximal exercise testing
Pulse oximetry or arterial blood gas
CHF Update 2018
Diet/exercise
Dietary consult
Diuretics
ACEI/ARB
Aldosterone antagonists
Hyralazine/nitrates
ARNI
CHF Update 2018
CHF Update 2018
Digoxin
Spironolactone
Neseritide
CHF Update 2018
CHF Update 2018
CHF Update 2018
CHF Update 2018
CRT
Simultaneous pacing of the RV/LV
CRT
Anatomic benefits:
• Decreased adverse LV remodeling
• Decreased LV size/spherical shape
• Increased LVEF
CHF Update 2018
Class IA
CRT
Class IIB
CRT
CLASS III
LVEF > 50%
QRS <120 msecs
Non-ambulatory NYHA Class IV
Patients on inotropic Rx
CHF Update 2018
Device Therapy
Summary Treatment Guidelines