Heart failure stages

Chlorthalidone (Hygroton) Heart failure stage A 6.25-25 (chlorthalidone)... 

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. 

How would you classify BE s NYHA functional class and ACC/AHA heart failure stage ... 

FIGURE 14-5. ACC/AHA heart failure staging system. (Adapted with permission from Circulation 2001 i04 2996-3007.)... 

Ammar KA, Jacobsen SJ, Mahoney DW, et al. Prevalence and prognostic significance of heart failure stages. Circulation 2007 115(12) 1563-70. 

Substances which promote the elimination of water by the kidney without major losses of salts (e.g. con-ivaptan, tolvaptan, SR121463A/B). They are particularly useful in situations where excess water needs to be eliminated without affecting the salt metabolism, like eu- or hypervolemic hyponatraemia, congestive heart failure, some stages of hypertension and some metabolic states. 

Digoxin-like immunore active substances (found in patients with chronic heart failure, end stage renal disease, liver disease, or third trimester of pregnancy) may cross-react with certain digoxin immunoassays and may result in a false elevation of levels... 

Creatinine clearance < 60 mL/min/1.73 m2 (stages III-V chronic kidney disease), diabetes mellitus (with renal insufficiency), hypertension, chronic heart failure, cirrhosis, nephrosis, age >75 yr, cholesterol emboli syndrome, multiple myeloma (questionable)... 

National and international trends over the past 15 years depict modest improvements in the treatment and/or control of blood pressure (BP) for hypertensive patients. This observation is made despite efforts to promote awareness, treatment, and the means available to aggressively manage high blood pressure. Over 65 million Americans have hypertension, which was listed as the primary cause of death for over 261,000 individuals in the United States in 2002.1 Hypertension is also a significant cause of end-stage renal disease and heart failure. National and international organizations continually refine their recommendations of how... 

IV C, D Patients with cardiac disease that results in an inability to carry on physical activity without discomfort. Symptoms of heart failure are present at rest. With any physical activity, increased discomfort is experienced. Stage D refers to end-stage heart failure patients. 

The ACC/AHA recommends that P-blockers be initiated in all patients with NYHA FC I to IV or ACC/AHA stages B through D heart failure if clinically stable.1 To date, only three p-blockers have been shown to reduce mortality in systolic HF, including the selective prantagonists bisoprolol and metoprolol succinate, and the non-selective pr, p2-, and arantagonist carvedilol.29 33 The positive findings should not be extrapolated to be indicative of a class effect, as bucindolol did not exhibit a beneficial effect on mortality when studied for HF, and there is limited information with propranolol and atenolol. 

FIGURE 3-1. Treatment algorithm for chronic heart failure. ACE, angiotensin-converting enzyme ARB, angiotensin receptor blocker EF, ejection fraction HF, heart failure LV, left ventricular Ml, myocardial infarction SOB shortness of breath. Table 3-5 describes staging of heart failure. 

Medications can increase the risk of hyperkalemia in patients with CKD, including angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, used for the treatment of proteinuria and hypertension. Potassium-sparing diuretics, used for the treatment of edema and chronic heart failure, can also exacerbate the development of hyperkalemia, and should be used with caution in patients with stage 3 CKD or higher. 

FIGURE 8-1. The American College of Cardiology/American Heart Association heart failure (HF) staging system. (Ml, myocardial infarction.)... 

Bakker PF, Meijburg HW, de Vries JW, et al. Biventricular pacing in end-stage heart failure improves functional capacity and left ventricular function. J. Interv. Card. Electrophysiol. 2000 4 395 404. 

Cazeau S, Ritter P, Lazarus A, et al. Multisite pacing for end-stage heart failure early experience. Pacing Clin. Electrophysiol. 1996 19 1748-57. 

Leclercq C, Cazeau S, Le Breton H, et al. Acute hemodynamic effects of biventricular DDD pacing in patients with end-stage heart failure. J. Am. Coll. Cardiol. 1998 32 1825-31. 

Molhoek SG, Van Erven L, Bootsma M, Steendijk P, Van Der Wall EE, Schalij MJ. QRS duration and shortening to predict clinical response to cardiac resynchronization therapy in patients with end-stage heart failure. Pacing Clin. Electrophysiol. 2004 27 308-13. 

Dipla K, Mattiello JA, Jeevanandum V, Houser SR, Margulies KB. Myocyte recovery after mechanical circulatory support in humans with end-stage heart failure. Circulation 1998 97 2316-2322... 

Radovancevic B, Vrtovec B, Frazier OH. Left ventricular assist devices an alternative to medical therapy for end-stage heart failure. Cwr Opin Cardiol 2003 18 210-214. 

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