Heart failure comorbidity

Assess the patient for IHD-related complications, such as heart failure. The presence of new comorbidities may indicate worsening IHD requiring additional workup or pharmacologic therapy. 

Prolonged exposure to elevated GH and IGP-Is can lead to serious complications in patients with acromegaly. Aggressively manage comorbid conditions such as hypertension, diabetes, arrhythmias, coronary artery disease and heart failure to prevent vascular and neuropathic complications. It is critical to monitor patients indefinitely for management of the comorbidities associated with acromegaly8 (Table 43-4). 

The comorbid conditions that can affect therapy and outcomes in patients with CAP include diabetes mellitus, COPD, congestive heart failure, and renal failure.27,28 If the patient has not received antibiotics in the past 3 months, then clarithromycin or azithromycin is the recommended first-line therapy by the IDSA. If the patient has received antibiotics in the last 3 months, then the IDSA recommends using either a respiratory fluoroquinolone alone or a combination of an oral P-lactam and an advanced macrolide/azalide (e.g., clarithromycin/azithromydn). The ATS recommends combination therapy or monotherapy with a respiratory fluoroquinolone for all patients with comorbidities. The p-lactam agents recommended include high-dose amoxicillin, high-dose amoxicillin-clavulanate, cefpodoxime, cefprozil, and cefuroxime. 

Comorbidities (chronic obstructive pulmonary disease, diabetes, renal or congestive heart failure, malignancy)... 

L A. Metformin causes lactic acidosis in patients with renal failure and severe congestive heart failure. It does not increase the risk of ketoacidosis and showed a reduction in cardiovascular comorbidities in a large study. It is contraindicated in patients with severe liver disease but does not cause hepatic necrosis. When used as monotherapy, metformin rarely causes hypoglycemia. 

The presence of multiple comorbid conditions (e.g., diabetes, asthma, congestive heart failure, obesity) further increases the risk of ADRs. Such patients may have altered physiology and some degree of end-organ dysfunction (e.g., renal, hepatic, cardiovascular, pulmonary). Conditions such as renal dysfunction may not be readily apparent in the elderly or in those with muscle wasting or malnutrition. 

The client has the comorbid condition of congestive heart failure. 

Lee DS, Donovan L, Austin PC, Gong Y, Liu PP et al. 2005. Comparison of coding of heart failure and comorbidities in administrative and clinical data for use in outcomes research. Med. Care 43 182-188. 

Cardiovascular toxicities have been observed in patients with a number of anticancer agents. These toxicities have included hypertension, cardiomyopathy, left ventricular dysfunction, congestive heart failure, infarction, and thrombosis. In most cases, the standard repeated-dose toxicology studies conducted in normal animals have failed to predict these clinical toxicities. One reason may be that other comorbidities need to be present before the treatment-related cardiovascular... 

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