Heart failure with

Heart Failure with Preserved Left Ventricular Ejection Fraction... 

Conduction system abnormalities are common in chronic heart failure, occurring in 15-30% of the population with low left ventricular ejection fraction (LVEF) [1-3]. The prevalence in ischemic heart disease is roughly similar to that seen in other forms of dilated cardiomyopathy. Conduction system disease can occur both at the time of an acute myocardial infarction as well as slowly progressing in chronic ischemic heart disease. Intraventricular conduction delays are associated with a poor prognosis in heart failure, with up to a 70% increase in the risk of death, and are also more prevalent in patients with advanced symptoms [2,4]. In ischemic heart disease, all components of the conduction system are at risk of ischemic injury, from the sinoatrial node to the His-Pukinje system. These conduction system abnormalities have the potential to impair cardiac function by a number of mechanisms. Since conduction abnormalities impair cardiac function, it is logical that pacing therapies to correct or improve these conduction abnormalities may improve cardiac function. 

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. 

Pachon JC, Pachon El, Albornoz RN, et al. Ventricular endocardial right bifocal stimulation in the treatment of severe dilated cardiomyopathy heart failure with wide QRS. Pacing Clin. Electrophysiol. 2001 24 1369-76. 

Outside the AMI setting, stem cells have been used to treat patients with ischemic heart disease with or without systolic functional compromise and patients unsuitable for myocardial revascularization (Tables 7.3 and 7.4). Autologous bone marrow stem cells have been used to treat patients with chronic myocardial ischemia, including ischemic heart failure with or without systolic functional compromise, and patients ineligible for myocardial revascularization (Table 7.4). The preliminary clinical evidence supports the efficacy of this new therapy and, at this point, all the evidence appears to substantiate its safety. 

Willenheimer R, van Veldhuisen DJ, Silke B, et al. Effect on survival and hospitalization of initiating treatment for chronic heart failure with bisoprolol followed by enalapril, as compared with the opposite sequence results of the randomized Cardiac Insufficiency Bisoprolol Study (CIBIS) III. Circulation. Oct 18 2005 112(16) 2426-2435. 

IV. Treatment of asymptomatic heart failure with structural abnormalities.595... 

IV. TREATMENT OF ASYMPTOMATIC HEART FAILURE WITH STRUCTURAL ABNORMALITIES... 

Case Study Congestive Heart Failure with Complications... 

Most clinical trials have been carried out in patients with systolic dysfunction, so the evidence regarding the superiority or inferiority of drugs in heart failure with preserved ejection fraction is meager. Most authorities support the use of the drug groups described above. Control of hypertension is particularly important, and revascularization should be considered if coronary artery disease is present. Tachycardia limits filling time therefore bradycardic drugs may be particularly useful, at least in theory. 

A 78-year-old man became short of breath. He had been taking rosiglitazone 8 mg/day for 6 months. He had renal insufficiency, atrial fibrillation, hypertension, and congestive heart failure, with pitting edema and bilateral pleural effusions. He was refractory to intravenous furosemide and metolazone. Withdrawal of rosiglitazone and administration of bumetanide gave a net fluid output of 9.5 litres and the edema resolved. 

Kobayacawa N, Sawaki D, Otani Y, Sekita G, Fukushima K, Takeuchi H, Aoyagi T. A case of severe diabetes melli-tus occurred during management of heart failure with car-vedilol and furosemide. Cardiovasc Drugs Ther 2003 17 295. 

Likewise, heart failure is not always associated with systolic dysfunction and an obvious decline in cardiac pumping ability. In approximately half the cases of symptomatic heart failure, systolic function and cardiac output may appear normal when the patient is at rest.53,63 In this type of heart failure, cardiac function is impaired because the left ventricle is stiff and unable to relax during the filling phase, resulting in increased pressures at the end of diastole.31 This condition is often described as diastolic heart failure, but it is also identified by other names such as heart failure with preserved left ventricular... 

Hogg K, Swedberg K, McMurrayJ. Heart failure with preserved left ventricular systolic function epidemiology, clinical characteristics, and prognosis. J Am Coll Cardiol. 2004 43 317-327. 

Sanderson JE. Diastolic heart failure or heart failure with a normal ejection fraction. Minerva Cardioangiol 2006 54 715-724. 

Chachques JC, Cattadori B, Herreros J, et al. Treatment of heart failure with autologous skeletal myoblasts. Herz 2002 27 570-578. 

Chlorothiazide [klor oh THYE a zide], the prototype thiazide diuretic, was the first modern diuretic that was active orally and was capable of affecting the severe edema of cirrhosis and congestive heart failure with a minimum of side effects. Its properties are representative of the thiazide group, although newer derivatives such as hydrochlorothiazide or chlorthalidone are now used more commonly. 

Heart failure with a dilated cardiomyopathy occurred in a 15-year-old boy with a 2-year history of intermittent solvent abuse (8). 

Hepatomegaly is found in most patients with moderately severe heart failure. With progressive cardiac failure, jaundice occurs in about 25% of patients and may progress to necrosis, fibrosis and cirrhosis. 

BETA-BLOCKERS LIDOCAINE 1. Risk of bradycardia (occasionally severe), 1 BP and heart failure with intravenous lidocaine 2. Risk of lidocaine toxicity due to t plasma concentrations of lidocaine, particularly with propranolol and nadolol 3. t plasma concentrations of propranolol and possibly some other beta-blockers 1. Additive negative inotropic and chronotropic effects 2. Uncertain, but possibly a combination of beta-blocker-induced reduction in hepatic blood flow (due to 1 cardiac output) and inhibition of metabolism of lidocaine 3. Attributed to inhibition of metabolism by lidocaine 1. Monitor PR, BP and ECG closely watch for development of heart failure when intravenous lidocaine is administered to patients on beta-blockers 2. Watch for lidocaine toxicity 3. Be aware. Regional anaesthetics should be used cautiously in patients with bradycardia. Beta-blockers could cause dangerous hypertension due to stimulation of alpha-receptors if epinephrine is used with focal anaesthetic... 

It is normal and comfortable to die slightly dehydrated full hydration leads to full urinary bladder (with discomfort, restlessness, incontinence), salivary drooling and death rattle it also increases heart failure (with dyspnoea which enhances death rattle) intravenous tubes make final embraces almost impossible (Lamerton R1991 Lancet 337 981). 

Soja, A.M. Mortensen, S.A Treatment of congestive heart failure with coenzyme QIO illuminated by meta-analyses of chnical trials. Mol. Aspects Med. 1997, 18 (SuppL), sl59-sl68. 

The angiotensin II receptor antagonists are being considered for the treatment of diseases other than hypertension (heart failure with or without left ventricular systolic dysfunction, during and after acute myocardial infarction, diabetic nephropathy, other forms of glomerulopathy, restenosis after coronary angioplasty, and atherosclerosis). 

Echemann M, Zannad F, Briancon S, JuUhere Y, Mertes PM, Virion JM, Villemot JP. Determinants of angiotensin-converting enzyme inhibitor prescription in severe heart failure with left ventricular systolic dysfunction the EPICAL study. Am Heart J 2000 139(4) 624-31. 

Dougherty AH, Naccarelli GV, Gray EL, Hicks CH, Goldstein RA. Congestive heart failure with normal systolic function. Am J Cardiol 1984 54(7) 778-82. 

Hamer J. The paradox of the lack of the efficacy of digitalis in congestive heart failure with sinus rhythm. Br J Clin Pharmacol 1979 8(2) 109-13. 

Bhattacharyya A, Tymms DJ. Heart failure with fludrocortisone in Addison s disease. J R Soc Med 1998 91(8) 433-4. 

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