Additional Information
Book Details
Abstract
Over 5.7 million people in America carry a diagnosis of heart failure, the incidence of which approaches 1 in 100 people over the age of 65. The cost to society is estimated at $29 billion annually and over 1.1 million hospital admissions. For hospitalized heart failure patients, the 30-day readmission rate approaches 25%. As our population ages these numbers are expected to grow. This issue of Cardiology Clinics helps practitioners to manage patients at all ACC/AHA stages of heart failure and addresses key issues that include sudden cardiac death, arrhythmias, acute decompensated heart failure, and heart failure with preserved ejection fraction.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Heart Failure\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Cardiology Clinics\r | xi | ||
| Preface | xiii | ||
| Epidemiology of Heart Failure and Scope of the Problem | 1 | ||
| Key points | 1 | ||
| Introduction | 1 | ||
| Disease description | 1 | ||
| Risk factors | 2 | ||
| Incidence in the United States and worldwide | 2 | ||
| Prevalence of HF in the United States and worldwide | 3 | ||
| Mortality of HF in the United States and worldwide | 4 | ||
| Clinical correlation | 4 | ||
| The Complex of Multiple-Comorbidity | 4 | ||
| Diagnostic criteria | 5 | ||
| Intervention and treatment | 5 | ||
| Summary | 6 | ||
| References | 6 | ||
| Pathophysiology and Etiology of Heart Failure | 9 | ||
| Key points | 9 | ||
| Introduction | 9 | ||
| Common pathophysiologic mechanisms in heart failure | 9 | ||
| Structural Heart Disease and Mechanical Stress: Pressure/Volume Overload | 9 | ||
| Neurohormonal Dysregulation | 11 | ||
| Ischemic Injury: Replacement Fibrosis and Hibernating Myocardium | 11 | ||
| Ultrastructural Abnormalities: Hypertrophy, Fibrosis, and Apoptosis | 12 | ||
| Abnormal Intracellular Calcium Handling | 13 | ||
| Genetic Mutations | 13 | ||
| Heart failure by etiology | 14 | ||
| Ischemic Cardiomyopathy | 14 | ||
| Idiopathic Dilated Cardiomyopathy | 15 | ||
| Hypertensive Heart Disease | 15 | ||
| Valvular Cardiomyopathy | 15 | ||
| Familial Cardiomyopathy | 15 | ||
| Inflammatory Cardiomyopathy | 16 | ||
| Infiltrative Cardiomyopathy | 16 | ||
| Toxic Cardiomyopathy | 16 | ||
| Summary | 16 | ||
| References | 16 | ||
| The Renin-Angiotensin-Aldosterone System and Heart Failure \r | 21 | ||
| Key points | 21 | ||
| Introduction | 21 | ||
| RAAS physiology | 21 | ||
| Systemic Actions of Angiotensin II | 22 | ||
| Cardiac Actions of Angiotensin II and Aldosterone | 22 | ||
| RAAS blockade with ACE inhibitors | 23 | ||
| ACE Inhibitors and Cardiac Remodeling | 23 | ||
| ACE Inhibitors and CV Outcomes in Chronic HF | 23 | ||
| ACE Inhibitors and the Prevention of HF | 24 | ||
| RAAS blockade with angiotensin-receptor blockers | 24 | ||
| ARBs and CV Outcomes in Chronic HF | 25 | ||
| CV Outcomes of Combination Therapy with ACE Inhibitors and ARBs | 27 | ||
| RAAS blockade with aldosterone antagonists | 27 | ||
| Aldosterone Antagonists in CV Outcomes Trials | 27 | ||
| RAAS blockade with a direct renin inhibitor | 28 | ||
| RAAS blockade in HF with preserved EF | 28 | ||
| Summary | 29 | ||
| References | 29 | ||
| The Sympathetic Nervous System and Heart Failure | 33 | ||
| Key points | 33 | ||
| Introduction | 33 | ||
| The autonomic nervous system and the heart | 33 | ||
| Anatomy | 34 | ||
| Physiology | 34 | ||
| Receptors | 34 | ||
| Reflex mechanism of sympathetic hyperactivity in heart failure | 34 | ||
| Afferent Pathways | 34 | ||
| Obstructive sleep apnea | 35 | ||
| Myocardial ischemia and infarction | 36 | ||
| Reflex from skeletal muscle | 36 | ||
| Renal failure | 36 | ||
| Efferent Pathways | 36 | ||
| Central mechanism of sympathetic hyperactivity in heart failure | 36 | ||
| Coupling of Renin-Angiotensin System and Reactive Oxidative Stress in Brain | 36 | ||
| Brain Inflammatory Mediators | 36 | ||
| Effect of sympathetic hyperactivity on heart failure | 37 | ||
| NE Spillover | 37 | ||
| Cardiac Remodeling | 37 | ||
| Receptor Level Changes | 37 | ||
| Impact of β-Adrenergic Receptor Polymorphism | 38 | ||
| Role of parasympathetic dysfunction in heart failure | 38 | ||
| Translation into Heart Failure: Diagnostic Implications | 38 | ||
| Muscle sympathetic nerve activity | 38 | ||
| Nuclear imaging | 38 | ||
| Other measurements | 39 | ||
| The sympathetic nervous system in heart failure: therapeutic implications | 39 | ||
| β-Blockers | 39 | ||
| α-Blockers | 39 | ||
| Centrally-Acting α2-Blockers | 41 | ||
| Renin-Angiotensin-Aldosterone Modulators | 41 | ||
| Digoxin | 41 | ||
| Exercise | 41 | ||
| Novel therapies and future perspectives | 41 | ||
| New Centrally Acting Medications | 41 | ||
| Parasympathetic stimulation | 42 | ||
| Renal sympathetic denervation | 42 | ||
| Combined SNS inhibition and stimulation | 42 | ||
| Future perspectives | 42 | ||
| Special categories in heart failure | 42 | ||
| Diastolic Heart Failure | 42 | ||
| Left Ventricular Assist Devices | 42 | ||
| Right Heart Failure | 43 | ||
| References | 43 | ||
| Evaluation of Patients with Heart Failure | 47 | ||
| Key points | 47 | ||
| Introduction | 47 | ||
| Definition of heart failure | 47 | ||
| Evaluation of patients with heart failure | 48 | ||
| History and Physical Examination | 49 | ||
| History | 49 | ||
| Physical examination | 50 | ||
| Evaluation of Causes and Complications | 51 | ||
| Laboratories | 51 | ||
| Routine laboratory testing | 51 | ||
| Supplemental laboratory assessments | 52 | ||
| Biomarkers | 52 | ||
| BNP | 52 | ||
| Cardiac troponin | 53 | ||
| Noninvasive assessment | 53 | ||
| Echocardiogram | 53 | ||
| Chest radiograph | 53 | ||
| Additional imaging techniques | 53 | ||
| Cardiac magnetic resonance | 53 | ||
| Nuclear imaging | 54 | ||
| Cardiac CT | 54 | ||
| Invasive assessment | 54 | ||
| Endomyocardial biopsy | 54 | ||
| Pulmonary artery catheter evaluation | 55 | ||
| Left heart catheterization | 55 | ||
| Prognostication | 55 | ||
| Scores | 55 | ||
| Functional testing | 55 | ||
| Biomarkers | 57 | ||
| Emerging Biomarkers and Novel Diagnostic Methods | 57 | ||
| Biomarkers of renal injury | 57 | ||
| Biomarkers of myocardial fibrosis | 57 | ||
| Noninvasive impedance cardiography | 57 | ||
| Summary | 58 | ||
| References | 58 | ||
| Management of ACCF/AHA Stage A and B Patients | 63 | ||
| Key points | 63 | ||
| Introduction | 63 | ||
| Stage A HF | 64 | ||
| CAD | 64 | ||
| Hypertension | 64 | ||
| Diabetes | 64 | ||
| Dyslipidemia | 65 | ||
| Metabolic syndrome, obesity, and physical inactivity | 65 | ||
| Sleep apnea | 65 | ||
| Renal disease | 65 | ||
| Smoking | 65 | ||
| Alcohol | 65 | ||
| Cardiotoxins | 65 | ||
| Right ventricular pacing | 66 | ||
| Tachycardia-induced cardiomyopathy | 66 | ||
| HIV | 66 | ||
| Endocrine disorders | 66 | ||
| Diagnostic modalities | 66 | ||
| Stage B HF | 67 | ||
| Management goals | 67 | ||
| Pharmacologic treatment | 67 | ||
| β-Blockers | 67 | ||
| ACE Inhibitors and ARBs | 67 | ||
| CCBs, Digoxin, and Aldosterone Antagonists | 68 | ||
| Nonpharmacological treatment | 68 | ||
| Summary | 68 | ||
| References | 69 | ||
| Management of ACCF/AHA Stage C Heart Failure | 73 | ||
| Key points | 73 | ||
| Stage C heart failure | 73 | ||
| Education and exercise | 73 | ||
| Sodium restriction | 74 | ||
| Obesity and obstructive sleep apnea | 74 | ||
| Pharmacologic therapy | 75 | ||
| Angiotensin-converting enzyme inhibitors | 75 | ||
| Angiotensin receptor blockers | 76 | ||
| Aldosterone antagonists | 77 | ||
| β-adrenergic blockade | 79 | ||
| Diuretics | 81 | ||
| Oral vasodilators | 82 | ||
| Digoxin | 83 | ||
| HF with preserved ejection fraction | 84 | ||
| Device therapy | 85 | ||
| Implantable Cardioverter-Defibrillator | 85 | ||
| Primary prevention | 85 | ||
| Secondary prevention | 85 | ||
| Cardiac Resynchronization Therapy | 86 | ||
| Surgical interventions | 87 | ||
| Coronary Artery Bypass Graft Surgery | 87 | ||
| Mitral Valve Repair | 88 | ||
| Ventricular Reconstruction | 88 | ||
| Summary | 88 | ||
| References | 88 | ||
| Management of the ACC/AHA Stage D Patient | 95 | ||
| Key points | 95 | ||
| Introduction | 95 | ||
| Evaluation for heart transplantation | 96 | ||
| Indications | 96 | ||
| Contraindications | 96 | ||
| Physiology of the transplanted heart | 96 | ||
| Lack of Innervation to the Transplantation Heart | 96 | ||
| Response to Medications | 98 | ||
| Immunosuppression | 98 | ||
| Induction Therapy | 98 | ||
| Purpose | 98 | ||
| Regimens | 99 | ||
| Maintenance Therapy | 99 | ||
| Steroid therapy | 99 | ||
| Mechanism of action | 99 | ||
| Management of the ACC/AHA Stage D Patient | 113 | ||
| Key points | 113 | ||
| Introduction | 113 | ||
| Indications for MCS | 114 | ||
| Beyond New York Heart Association class: INTERMACS profiles | 116 | ||
| Key trials in MCS | 116 | ||
| Patient perspective: life with an MCS device | 120 | ||
| What could possibly go wrong? Modes of failure of MCS devices | 122 | ||
| Future trends | 122 | ||
| Summary | 123 | ||
| References | 123 | ||
| Arrhythmias and Heart Failure | 125 | ||
| Key points | 125 | ||
| Atrial fibrillation | 125 | ||
| Prevalence | 125 | ||
| Association Between Heart Failure and Atrial Fibrillation | 125 | ||
| Atrial Fibrillation Precipitating Heart Failure | 126 | ||
| Pathophysiology | 126 | ||
| Heart Failure Precipitating Atrial Fibrillation | 127 | ||
| Therapeutic Considerations | 127 | ||
| Rate or rhythm control | 127 | ||
| Ventricular-rate control | 127 | ||
| Rhythm restoration or control | 127 | ||
| Atrial Fibrillation and Pacemaker Therapy | 128 | ||
| Ventricular arrhythmias | 128 | ||
| Medical Therapy for Ventricular Arrhythmias in Heart Failure | 129 | ||
| References | 130 | ||
| Sudden Cardiac Death in Heart Failure | 135 | ||
| Key points | 135 | ||
| Introduction | 135 | ||
| Pathophysiology | 136 | ||
| Epidemiology | 137 | ||
| Risk stratification | 137 | ||
| Left Ventricular Ejection Fraction | 137 | ||
| Ventricular Ectopy | 138 | ||
| Microvolt T-wave Alternans | 138 | ||
| Heart Rate Variability and Baroreflex Sensitivity | 138 | ||
| Signal-averaged ECG | 138 | ||
| Electrophysiology Studies | 138 | ||
| Cardiac Magnetic Resonance Imaging | 139 | ||
| I-123 Metaiodobenzylguanidine | 139 | ||
| Prevention and treatment of sudden death | 139 | ||
| Pharmacologic Therapies | 139 | ||
| Coronary Revascularization | 139 | ||
| ICDs | 139 | ||
| Cardiac Resynchronization Therapy | 140 | ||
| Wearable Cardioverter-Defibrillators | 141 | ||
| Summary | 141 | ||
| References | 141 | ||
| Managing Acute Decompensated Heart Failure | 145 | ||
| Key points | 145 | ||
| Introduction: nature of the problem | 145 | ||
| Management goals | 146 | ||
| Pharmacologic strategies | 146 | ||
| Hemodynamic strategies | 147 | ||
| Self-management strategies | 148 | ||
| Evaluation and adjustment | 148 | ||
| Summary | 149 | ||
| References | 149 | ||
| Heart Failure with Preserved Ejection Fraction | 151 | ||
| Key points | 151 | ||
| Introduction | 151 | ||
| Epidemiology | 152 | ||
| Pathophysiology | 152 | ||
| Differential diagnosis | 153 | ||
| Outcomes | 154 | ||
| Treatment | 154 | ||
| Controlling Comorbid Conditions | 154 | ||
| Pharmacologic Treatment: Review of the Evidence | 154 | ||
| Other ongoing investigations | 157 | ||
| Summary | 158 | ||
| References | 158 | ||
| Adjunctive Therapy and Management of the Transition of Care in Patients with Heart Failure | 163 | ||
| Key points | 163 | ||
| Introduction: nature of the problem | 163 | ||
| Management goals | 164 | ||
| Pharmacologic strategies | 165 | ||
| Diuretics | 165 | ||
| Angiotensin-converting Enzyme Inhibitors/Angiotensin Receptor Blockers | 166 | ||
| β-Blockers | 166 | ||
| Aldosterone Antagonists | 166 | ||
| Digoxin | 167 | ||
| Hydralazine and Nitrates | 167 | ||
| Other Pharmacologic Agents | 167 | ||
| Nonpharmacologic strategies | 168 | ||
| Diet in Heart Failure | 168 | ||
| Cardiac Rehabilitation and Exercise | 168 | ||
| Evaluation for Implantable Cardioverter-Defibrillator | 168 | ||
| Cardiac Resynchronization Therapy | 169 | ||
| Smoking, Alcohol, and Substance Abuse Cessation | 169 | ||
| Self-management Strategies | 170 | ||
| Evaluation, adjustment, recurrence | 170 | ||
| Adjustments | 171 | ||
| Recurrence | 171 | ||
| Palliative care in heart failure | 172 | ||
| Summary | 172 | ||
| References | 172 | ||
| Index | 175 |