Heart Failure Guidelines

Heart failure has become a health problem in the past two decades. Data from several studies have increased our understanding of the clinical data of patients hospitalized for worsening heart failure. These studies show that most patients hospitalized for heart failure have evidence of hypertension at admission and usually kept a left ventricular ejection fraction (LVEF). Patients with severe systolic function, hypertension and symptoms of poor blood supply to target organs are a clear minority. Medical studies have shown that ICAD is a high risk period for patients, where the probability of death and rehospitalisation is significantly greater than in the corresponding period of chronic heart failure, but stable.

Heart Failure Guidelines

There is a lack of data from controlled clinical studies to define optimal treatment for patients with acute heart failure. The few studies have focused on relieving symptoms, not the results, and have mostly included patients with reduced LVEF been not hypertensive. To determine the best care processes to achieve several goals for patients admitted with ADHF is still missing in clinical studies. The recommendations in this section to resolve common therapeutic dilemmas associated with the large group of patients with ICAD using the best available clinical research and expert consensus opinion.

In addition to laboratory tests as specified in the guidelines from the ESC, was taken into account:

• The following laboratory tests are not necessary in all patients with acute heart failure, but should be used as clinically indicated: C-reactive protein, D-dimer, CK-MB.

• At this stage, plasma B-type natriuretic peptide (BNP) better be interpreted as a “rule of evidence”, ie a normal level essentially excludes the diagnosis acute heart failure that causes breathlessness.

• Any patients with acute heart failure require an echocardiogram as soon as possible. While acknowledging that it depends on local availability, echocardiography should be organized during the hospital stay.

Therapeutic approaches

• Excessive use of high doses of intravenous diuretics should be avoided. nitrates intravenously is an effective way to reduce pre-load and must be used in acute heart failure that occurs with adequate blood pressure.

• The hemodynamic response to inotropic agents may be affected by the basic use of beta-blockers. Milrinone or levosimendan (two drugs that work through b-receptors) are preferred as the dose of b-blockers can be maintained or reduced to a minimum.

• Cardioversion of atrial fibrillation, either electrical or chemical poses a risk similar to distal embolization. Thus, both methods require the same measures anticoagulatory.

Medication

• All intravenous b-blockers

• enoximone

• norepinephrine

• Nesiritide

• Dofetalide

The following medications are available for use:

• Levosimendan

Guidelines for chronic heart failure

Diagnosis

Although the benefits of magnetic resonance imaging of the heart (cardiac MRI) is recognized, it is recognized that cardiac MRI requires special software and an experienced radiologist an accurate assessment.

The main guidelines for heart failure

• The first evaluation and clinical studies of patients with heart failure (initial assessment and identification of patients, identification of structural and functional abnormalitities, laboratory tests and prognosis).

• Treatment of patients with reduced LVEF (ventricular arrhythmias and the prevention of death, hydralazine and isosorbide dinitrate therapy for sudden cardiac resynchronization therapy, intermittent intravenous [IV] positive inotropic)

• Treatment of patients with refractory heart failure with the terminal (use of peripheral vasodilators and positive inotropic IV)

• Treatment for specific populations

• Treatment of patients with heart failure and related disorders such as supraventricular arrhythmias.

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