Heart failure classification

Identify signs and symptoms of heart failure and classify a given patient by the New York Heart Association Functional Classification and American College of Cardiology/American Heart Association Heart Failure Staging. 

Obtain spirometry measurements to assess airflow limitation and aid in severity classification and treatment decisions. Measure arterial blood gases if FEV is less than 40% predicted or if the patient has clinical signs suggestive of respiratory failure or right heart failure. 

Measurements of arterial pressure, cardiac output, stroke work index, and pulmonary capillary wedge pressure are particularly useful in patients with acute myocardial infarction and acute heart failure. Such patients can be usefully characterized on the basis of three hemodynamic measurements arterial pressure, left ventricular filling pressure, and cardiac index. One such classification and therapies that have proved most effective are set forth in Table 13-4. When filling pressure is greater than 15 mm Hg and stroke work index is less than 20 g-m/m2, the mortality rate is high. Intermediate levels of these two variables imply a much better prognosis. 

Her research into heart failure has given her some information about what types of variables she should collect. Patients with heart failure show symptoms of decreased exercise tolerance, shortness of breath, increased fatigue, and fluid buildup in the lungs and tissues. Patients with heart failure are also classified clinically by their level of disability so that they may be followed longitudinally and provide a reference point when compared with other patients. This classification system is the New York Heart Association (NYHA) Functional Classification system and ranges from functional class I (no limitation of physical activity) to functional class IV (unable to carry on physical activity without discomfort) (Criteria Committee, 1973). 

Anemia baseline hematocrit value <39% for men and >36% for women congestive heart failure class III/1V by New York Heart Association classification and/or history of pulmonary edema Hypotension systolic blood pressure <80mmHg for at least 1 hr requiring inotropic support with medications or intra-aortic balloon pump (IABP) within ... 

The New York Heart Association (NYHA) classification is a well-accepted classification of heart failure based on the severity of symptoms ... 

Amiodarone and carvedilol have been used in combination in 109 patients with severe heart failure and left ventricular ejection fractions of 0.25 (16). They were given amiodarone 1000 mg/week plus carvedilol titrated to a target dose of 50 mg/day. A dual-chamber pacemaker was inserted and programmed in back-up mode at a basal rate of 40. Significantly more patients were in sinus rhythm after 1 year, and in 47 patients who were studied for at least 1 year the resting heart rate fell from 90 to 59. Ventricular extra beats were suppressed from 1 to 0.1/day and the number of bouts of tachycardia over 167 per minute was reduced from 1.2 to 0.3 episodes per patient per 3 months. The left ventricular ejection fraction increased from 0.26 to 0.39 and New York Heart Association Classification improved from 3.2 to 1.8. The probability of sudden death was significantly reduced by amiodarone plus carvedilol compared with 154 patients treated with amiodarone alone and even more so compared with 283 patients who received no treatment at all. However, the study was not randomized, and this vitiates the results. The main adverse effect was s)mptomatic bradycardia, which occurred in seven patients two of those developed atrioventricular block and four had sinoatrial block and/or sinus bradycardia one patient developed slow atrial fibrillation. 

New York Heart Association Class Figure 44-17 Correlation of BNP concentrations (Biosite Triage) according to NYHA classification of heart failure. (From Maisel AS, Krisbnaswamy R Nowak RM, McCord J, Hollander JE, Due R ef al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002 347 ... 

Recent studies demonstrate that cardiac resynchronization therapy (CRT) offers a promising approach to selected patients with chronic heart failure. Delayed electrical activation of the left ventricle, characterized on the ECG by a QRS duration that exceeds 120 ms, occurs in approximately one-third of patients with moderate to severe systolic heart failure. Since the left and right ventricles normally activate simultaneously, this delay results in asynchronous contraction of the left and right ventricles, which contributes to the hemodynamic abnormalities of this disorder. Implantation of a speciahzed biventricular pacemaker to restore synchronous activation of the ventricles can improve ventricular contraction and hemodynamics. Recent trials show improvements in exercise capacity, NYHA classification, quality of life, hemodynamic function, and hospitalizations. A device that combined CRT with an implantable cardioverter-defibrillator (ICD) improved survival in addition to functional status. CRT is currently indicated only in NYHA class ni-IV patients receiving optimal medical therapy (ACE inhibitors, diuretics, -blockers, and digoxin) and... 

D in the ACC/AHA classification scheme)."" " The terms decompensated heart failure and exacerbation of heart failure refer to patients with acute worsening of their baseline symptoms that is usually caused by volume overload and/or hypoperfusion. Irrespective of the term used, these forms of severe heart failure may be caused by progression of the underlying disorder or by other intercurrent events that result in worsening of the patient s symptoms. Early identification and aggressive management of patients with advanced heart failure hopefully will reduce morbidity, mortality, and cost of care. 

AMI acute myocardial infarction CHF congestive heart failure NYHA New York Heart Association classification of heart failure. ... 

As mentioned earlier, this SRK model will form the basis for the Eindhoven classification model of system failure in process control tasks (see Chapter 5), which in turn is the analytical heart of the framework to design near miss reporting systems proposed in Chapter 4. 

The degree of severity of myocardial failure is categorized according to the New York Heart Association (NYHA) Functional Classification System Stages I—IV reflect an increasing level of disability. 

Advanced age, heart rate, systolic blood pressure, diabetes mellitus, recurrent or persistent pain. The prognosis is worse in diabetics and elderly patients, especially in presence of renal failure, sinus tachycardia and evident haemodynamic impairment (hypotension, pulmonary oedema, etc.) (grade 3-4 of Killip classification) (Wiviott et al, 2006). 

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