Treatment
This chapter will emphasize the therapeutic approach to the patient with chronic
heart failure. Several societies have issued guidelines for the treatment of
patients with congestive heart failure. These include the 2005 American College
of Cardiology/ American Heart Association (ACC/AHA) Guidelines, the 2005
European Society of Cardiology (ESC) Guidelines, the 2006 Canadian
Cardiovascular Society Consensus Conference, and the 2006 Heart Failure
Society of America Guidelines. With the exception of few things, the
recommendations are very similar. The treatment of chronic heart failure should
begin with recognition by the primary care physician of systemic factors that may
precipitate or exacerbate heart failure. A few examples include thyroid
malfunctioning including hyper or hypothyroidism, uncontrolled diabetes,
worsening renal function, renal artery stenosis, and infections. Medications like
nonsteroidal anti-inflammatory drugs, calcium channel blockers,
thiazolidinediones, and antiarrhythmic drugs all may contribute to worsening
Marwan Nasif 7
symptoms of heart failure and fluid retention. Patients should receive influenza
and pneumococcal vaccinations per guidelines. Despite the recent advances in
drugs with increased survivals, patient education and lifestyle modifications are
fundamental in achieving good control of the disease, decreasing hospitalization,
and improving survival. First line drugs recommended to treat patient with
congestive heart failure are:
Stage A — High risk for HF, without structural heart disease or symptoms
Stage B — Heart disease with asymptomatic left ventricular dysfunction
Stage C — Prior or current symptoms of HF
Stage D — Refractory end stage HF
TreatmentThis chapter will emphasize the therapeutic approach to the patient with chronicheart failure. Several societies have issued guidelines for the treatment ofpatients with congestive heart failure. These include the 2005 American Collegeof Cardiology/ American Heart Association (ACC/AHA) Guidelines, the 2005European Society of Cardiology (ESC) Guidelines, the 2006 CanadianCardiovascular Society Consensus Conference, and the 2006 Heart FailureSociety of America Guidelines. With the exception of few things, therecommendations are very similar. The treatment of chronic heart failure shouldbegin with recognition by the primary care physician of systemic factors that mayprecipitate or exacerbate heart failure. A few examples include thyroidmalfunctioning including hyper or hypothyroidism, uncontrolled diabetes,worsening renal function, renal artery stenosis, and infections. Medications likenonsteroidal anti-inflammatory drugs, calcium channel blockers,thiazolidinediones, and antiarrhythmic drugs all may contribute to worseningMarwan Nasif 7symptoms of heart failure and fluid retention. Patients should receive influenzaand pneumococcal vaccinations per guidelines. Despite the recent advances indrugs with increased survivals, patient education and lifestyle modifications arefundamental in achieving good control of the disease, decreasing hospitalization,and improving survival. First line drugs recommended to treat patient withcongestive heart failure are: Stage A — High risk for HF, without structural heart disease or symptoms Stage B — Heart disease with asymptomatic left ventricular dysfunction Stage C — Prior or current symptoms of HF Stage D — Refractory end stage HF
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