Heart failure patient history

History of hypersensitivity to aspirin or another NSAID, severe heart failure, patients with previous or active peptic ulceration... 

Diclofenac is contraindicated in those with a history of hypersensitivity to aspirin or another NSAID, severe heart failure, patients with previous or active peptic ulceration, or porphyria. It should be avoided in pregnancy. It should be used with caution in patients with allergic disorders, renal, hepatic and cardiac impairment, the elderly, in lactation and in those with coagulation defects. 

A careful history and physical examination are key components in the diagnosis of decompensated heart failure. The history should focus on the potential etiologies of heart failure the presence of any precipitating factors onset, duration, and severity of symptoms and a careful medication history. Important elements of the physical examination include vital signs, cardiac auscultation for heart sounds and murmurs, pulmonary examination for the presence of rales, the presence of peripheral edema, and weight. The JVP is a reliable indicator of the patient s volume status and should be evaluated carefully on admission and followed closely as an indicator of the efficacy of diuretic therapy. 

Introduction A number of risk factors have been identified for perioperative cardiovascular complications, and are used for risk stratification of patients for surgery. These include a history of ischemic heart disease, myocardial dysfunction, or a history of compensated heart failure, a history of cerebrovascular disease, diabetes mellitus, and renal insufficiency. Patients in these risk categories are very likely to be taking one or more antihypertensive medications, both to control arterial hypertension and as therapy for other underlying diseases. Preoperative evaluation is an opportunity to optimize control of cardiovascular risk factors and review medication requirements. 

The MAOI antidepressant drag s are contraindicated in patients widi known hypersensitivity to die drug s, liver and kidney disease, cerebrovascular disease, hypertension, or congestive heart failure and in die elderly. These drag s are given cautiously to patients witii impaired liver function, history of seizures, parkinsonian symptoms, diabetes, or hyperthyroidism. 

Epoetin alfa and darbepoetin alfa are used with caution in patients with hypertension, heart disease, congestive heart failure, or a history of seizures. Both of these drains are Pregnancy Category C dru and are used cautiously during pregnancy and lactation. 

Heart failure is a clinical syndrome characterized by a history of specific signs and symptoms related to congestion and hypoperfusion. As HF can occur in the presence or absence of fluid overload, the term heart failure is preferred over the former term congestive heart failure. Heart failure results from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood.1 Many disorders such as those of the pericardium, epicardium, endocardium, or great vessels may lead to HF, but most patients develop symptoms due to impairment in left ventricular (LV) myocardial function. 

The phrase acute heart failure (AHF) is used to signify either an acute decompensation of a patient with a history of chronic heart failure or to refer to a patient presenting with new-onset HF symptoms. Terms commonly associated with HF, such as cardiomyopathy and LV dysfunction, are not equivalent to HF but describe possible structural or functional reasons for the development of HF. 

A 57-year-old African-American man presents to the clinic for follow-up management of UC. He has had left-sided disease for 3 years and has been maintained in remission on maximal doses of oral mesalamine and prednisone 35 mg orally once daily. His provider has attempted several times to taper the prednisone dose, but the patient experiences a reappearance of symptoms if the dose is lowered below this level. Medical history is also significant for hypertension and heart failure. He has no known drug allergies. 

Of the following agents, which is best avoided in a patient with a history of chronic congestive heart failure (CHF) ... 

Although the risk of GI complications is relatively small with short-term therapy, coadministration with a proton pump inhibitor should be considered in elderly patients and others at increased GI risk. NSAIDs should be used with caution in individuals with a history of peptic ulcer disease, heart failure, uncontrolled hypertension, renal insufficiency, coronary artery disease, or if they are receiving anticoagulants concurrently. 

Adrenocorticotropic hormone (ACTH) gel, 40 to 80 USP units, may be given intramuscularly every 6 to 8 hours for 2 to 3 days and then discontinued. Studies with ACTH are limited, and it should be reserved for patients with contraindications to first-line therapies (e.g., heart failure, chronic renal failure, history of GI bleeding). 

Cardiac failure Avoid use in overt CHF may be used with caution in patients with a history of heart failure who are well compensated. CHF has been observed in patients receiving labetalol. 

Seizures Methylphenidate may lower the convulsive threshold in patients with history of seizures, in patients with prior EEG abnormalities in the absence of a history of seizures, and, very rarely, in the absence of a history of seizures and no prior EEG evidence of seizures. In the presence of seizures, discontinue the drug. Hypertension and other cardiovascular conditions Use cautiously in patients with hypertension. Monitor blood pressure at appropriate intervals in all patients taking dexmethylphenidate, especially those with hypertension. Caution is indicated in treating patients whose underlying medical conditions might be compromised by increases in blood pressure or heart rate (eg, pre-existing hypertension, heart failure, recent Ml, hyperthyroidism). 

Hypersensitivity to this or any product of murine origin anti-mouse antibody titers greater than or equal to 1 1000 patients in fluid overload or uncompensated heart failure, as evidenced by chest x-ray or greater than 3% weight gain within the week prior to treatment history of seizures or predisposition to seizures pregnancy breastfeeding. 

Atrial fibrillation is commonly associated with heart failure, and the prevalence of atrial fibrillation is related to the severity of heart failure, with less than 5% affected with very mild heart failure to nearly 50% affected with advanced heart failure [66]. Heart failure and atrial fibrillation are both common cardiovascular disorders and share the same demographic risk factors, including age, history of hypertension, prior myocardial infarction, and valvular heart disease [67, 68]. Further, the incidence of heart failure increases dramatically after the diagnosis of atrial fibrillation [69]. Progression of LV dysfunction can clearly be associated with rapid ventricular rates [70-76]. Conversely, conversion to normal sinus rhythm or control of ventricular response in atrial fibrillation can improve LV function [71-74, 77]. Accordingly, rate control becomes very important in patients with heart failure and dilated cardiomyopathy, and likely even more so when ischemia from rapid rates complicate the patient s course. 

Bnnch TJ, Mnhlestein JB, Bair TL, Renlnnd DG, Lappe DL, Jensen KR et al. Effect of beta-blocker therapy on mortality rates and future myocardial infarction rates in patients with coronary artery disease but no history of myocardial infarction or congestive heart failure. Am J Cardiol 2005 95(7) 827-31. 

Administration of one of the jS-blockers and an ACE-I is mandatory for all patients with a recent MI, regardless of the ejection fraction (EE). If the LVEE is reduced in patients without a history of MI, yS-blockers and/or ACE-I should be administrated as long as the patients do not have heart failure symptoms. If an ACE-I is contraindicated, it has to be substituted by an ARB, if the patient is post-MI with low EE, but no manifest HF. This may also be true without a history of MI. ACE-I and ARB are beneficiary for those with hypertension and left ventricular hypertrophy (LVH), without HF symptoms. 

As with other antiarrhythmic drugs, moricizine has proarrhythmic activity, which may manifest as new ventricular ectopic beats or a worsening of preexisting ventricular arrhythmias. These effects are most common in patients with depressed left ventricular function and a history of congestive heart failure. Cardiovascular ef-... 

Theophylline should be used with caution in patients with myocardial disease, liver disease, and acute myocardial infarction. The half-life of theophylline is prolonged in patients with congestive heart failure. Because of its narrow margin of safety, extreme caution is warranted when coadministering drugs, such as cime-tidine or zUeuton, that may interfere with the metabolism of theophylline. Indeed, coadministration of zileu-ton with theophylline is contraindicated. It is also prudent to be careful when using theophylline in patients with a history of seizures. 

As noted earlier, lithium is contraindicated in patients with unstable congestive heart failure or the sick sinus node syndrome ( 307, 328). In older patients or those with prior cardiac histories, a pretreatment ECG should be obtained. Except for the potential adverse interactions with diuretics, the concomitant use of other cardiac drugs is generally safe. Because verapamil may lower serum levels of lithium, however, more careful monitoring may be required to assure continued therapeutic effects (329). Some data also indicate that verapamil may predispose to lithium neurotoxicity. Conversely, increased lithium levels leading to toxicity has occurred with methyidopa and enalapril. When antihypertensive therapy is necessary, b-blockers are a reasonable choice when lithium is coadministered. 

This drug is only approved for oral administration in some countries. It is effective for conversion of atrial flutter or fibrillation or ischaemia-induced ventricular arrhythmias. It has significant anticholinergic properties (10% of the potency of atropine) that can offset its direct depressant effects on sinus and AV nodes. It has a pronounced negative inotropic effect and should be administered with caution to patients with a history of congestive heart failure. For acute treatment of perioperative arrhythmias it is given intravenously 0.2 mg-kg-1 over 10-15 min, then 0.2 mg-kg-1 over the next 45 min and a maintenance infusion of 0.4 mg-kg-l-h-1. 

Amantadine should be used with caution in patients with a history of seizures or heart failure. 

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