Changing Strategies in the Management of Chronic Congestive Heart Failure

DICP ◽  
1991 ◽  
Vol 25 (12) ◽  
pp. 1349-1354 ◽  
Author(s):  
Daniel E. Hilleman ◽  
Syed M. Mohiuddin
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Mortality Rate ◽  
Heart Transplantation ◽  
Nyha Class ◽  
Class Ii ◽  
Left Ventricular ◽  
Fixed Dose ◽  
Chronic Congestive Heart Failure ◽  
Organ Systems

Recent studies have more clearly defined the role of drug therapy in patients with chronic congestive heart failure (CHF). Treatment of patients with asymptomatic left ventricular dysfunction (New York Heart Association [NYHA] class I) cannot be recommended at this time. The benefit of prophylactic treatment with angiotensin-converting enzyme inhibitors (ACEIs) or vasodilators in patients at high risk for developing symptomatic CHF is currently being evaluated. Treatment of patients with symptomatic CHF (NYHA class II-IV) should be initiated with a combination of a diuretic, digoxin, and an ACEI. This combination has been shown to reduce the mortality rate in patients with NYHA class II-IV CHF. Patients who remain symptomatic despite treatment with this combination may benefit from the addition of the direct-acting, nonspecific vasodilators—hydralazine and a nitrate. The addition of the nonspecific vasodilators to an ACEI has not been tested in controlled trials. In patients who remain symptomatic despite treatment with diuretics, digoxin, ACEIs, and nonspecific vasodilators, treatment options are not clear. The use of beta-agonists, phosphodiesterase inhibitors, and intermittent fixed-dose, fixed-interval dobutamine should be avoided as these agents are associated with a high mortality rate. Heart transplantation should be considered early in the course of CHF to allow for preservation of other vital organ systems. Unfortunately, heart transplantation is available to only a very small minority of potential transplant candidates.

scholarly journals Degenerative Pathology of the Ankle, Hindfoot, and Midfoot is as Limiting to Patient Mobility as Congestive Heart Failure

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0016
Author(s):  
Amalie Erwood ◽  
Gregory Kurkis ◽  
Samuel David Maidman ◽  
Robert Cole ◽  
Shay Ariel Tenenbaum ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Nyha Class ◽  
Class Ii ◽  
Study Patient ◽  
Foot And Ankle ◽  
Ankle Arthritis ◽  
Patient Mobility ◽  
Patient Demographics ◽  
Significant Difference

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Degenerative conditions of the ankle, hindfoot, and midfoot can markedly limit mobility. The Life-Space Assessment (LSA) is a questionnaire quantifying how patients mobilize after a medical event as they return to their previous daily settings. Current outcome measures do not accurately assess mobility in the geriatric foot and ankle population. In contrast, the effect of congestive heart failure (CHF) on patient mobility is routinely assessed via the New York Heart Association (NYHA) functional classification. The NYHA classification is stratified by limitation of physical activity: I (no limitation), II (some limitation), III (marked limitation), and IV (unable to carry out without discomfort). We hypothesized that degenerative conditions of the foot and ankle would be as mobility limiting as CHF. Methods: Patients over the age of 50 were included in this study. LSA data was prospectively collected from patients with degenerative ankle, hindfoot, and midfoot diagnoses at their preoperative visit and NYHA-classified CHF patients at a cardiology clinic. The degenerative foot and ankle cohort included Achilles tendonitis, ankle joint cartilage defects, ankle arthritis, subtalar arthritis, and midfoot arthritis. Patient demographics and comorbidities were recorded from the electronic medical record. Mean LSA data was analyzed and compared using a Student’s t-test. Results: 28 degenerative foot and ankle patients and 44 CHF patients met inclusion criteria for the study. Patient demographics, including age, gender, and BMI, were not significantly different between the two groups. The foot and ankle cohort had a mean LSA score of 68. Mobility of the foot and ankle group was significantly less compared to NYHA class I patients, who had a LSA score of 103 (p=0.008). There was no significant difference in mobility compared to class II or III congestive heart failure patients, who recorded a mean LSA score of 62 (p=0.60). There was insufficient data available on NYHA class IV patients to make comparisons to this group. Conclusion: Degenerative ankle, hindfoot, and midfoot pathology is associated with similar mobility limitation to that of NYHA class II and III congestive heart failure.

Trimazosin in chronic congestive heart failure: Improved left ventricular function at rest and during exercise

1983 ◽  
Vol 106 (5) ◽  
pp. 1036-1042 ◽  
Author(s):  
Thomas A Ports ◽  
Kanu Chatterjee ◽  
Peter Wilkinson ◽  
Deborah Avakian ◽  
William W Parmley
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Left Ventricular ◽  
Chronic Congestive Heart Failure

scholarly journals Effect of dapagliflozin therapy on achieving cardiovascular mortality target indicators in patients with heart failure

2021 ◽  
Vol 26 (12) ◽  
pp. 4800
Author(s):  
M. V. Zhuravleva ◽  
S. N. Tereshchenko ◽  
I. V. Zhirov ◽  
S. V. Villevalde ◽  
T. V. Marin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiovascular Mortality ◽  
Patient Population ◽  
Standard Therapy ◽  
Nyha Class ◽  
Class Ii ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Patients With Heart Failure

Aim. To assess the effect of therapy with sodium glucose co-transporter type 2 inhibitor dapagliflozin in patients with heart failure with reduced ejection fraction (CHrEF) on the state cardiovascular mortality target indicators.Material and methods. All adult Russian patients with NYHA class II-IV HFrEF (left ventricular ejection fraction ≤40%) were considered as the target population. The characteristics of patients in the study corresponded to those in the Russian Hospital HF Registry (RUS-HFR). The study suggests that the use of dapagliflozin in addition to standard therapy will be expanded by 10% of the patient population annually in 2022-24. Cardiovascular mortality modeling was performed based on the extrapolation of DAPA-HF study result. The number of deaths that can be prevented was calculated when using dapagliflozin in addition to standard therapy. Further, the contribution of prevented deaths with dapagliflozin therapy to the achievement of federal and regional cardiovascular mortality target indicators (1, 2 and 3 years) was calculated.Results. The use of dapagliflozin in addition to standard therapy for patients with NYHA class II-IV CHrEF with the expansion of dapagliflozin therapy by 10% of the patient population annually will additionally prevent 1729 cardiovascular death in the first year. This will ensure the implementation of cardiovascular mortality target indicators in Russia in 2022 by 11,8%. In the second year, 3769 cardiovascular deaths will be prevented, which will ensure the implementation of target indicators in 2023 by 17,2%. In the third year, 5465 cardiovascular deaths prevented, which will ensure the implementation of implementation of target indicators in 2024 by 18,7%.Conclusion. The use of dapagliflozin in addition to standard therapy for patients with NYHA class II-IV CHrEF will ensure the implementation of implementation of target indicators in 2024 by 18,7%.

Ambulatory Blood Pressure and Physical Activity in Heart Failure

2009 ◽  
Vol 11 (3) ◽  
pp. 269-279
Author(s):  
Mei-Kuei Tai ◽  
Janet C. Meininger ◽  
Lorraine Q. Frazier ◽  
Wenyaw Chan
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Blood Pressure ◽  
Functional Status ◽  
Ambulatory Blood Pressure ◽  
Nyha Class ◽  
Class Ii ◽  
Left Ventricular ◽  
Class I ◽  
Left Ventricular Ejection

This observational study used repeated measures over 24 hr to investigate ambulatory blood pressure (BP) and physical activity (PA) profiles in community-based individuals with heart failure (HF). The aims were to (a) compare BP dipping and PA between two groups of HF patients with different functional statuses, and (b) determine whether the strength of the association between ambulatory BP and PA varies by functional status in HF. Ambulatory BP was measured every 30 min with a SpaceLabs 90207; a Basic Motionlogger actigraph was used to measure PA minute-by-minute. Fifty-six participants (54% female, age 66.96 ± 12.35 years) completed data collection. Functional status was based on New York Heart Association (NYHA) ratings. Twenty-seven patients had no limitation of PA (NYHA Class I HF), whereas 29 had some limitation of PA but no discomfort at rest (NYHA Class II or III HF). Patients with Class I HF had a significantly greater degree of BP dipping than those with Class II/III HF after controlling for left ventricular ejection fraction. In a mixed-model analysis, PA was significantly related to ambulatory systolic and diastolic BP and mean arterial pressure. The strength of the association between PA and BP was not significantly different for the two groups of patients. These findings demonstrate differences between Class I and Class II/II HF in BP dipping status and ambulatory BP but not PA. Longitudinal research is recommended to improve understanding of the influence of disease progression on changes in 24-hr PA and BP profiles of patients with HF.

scholarly journals FVC, FEV1, FEV1/FVC % and their Relationship with EF% in Patients with Chronic Heart Failure

2020 ◽  
Vol 16 (2) ◽  
pp. 59-64
Author(s):  
Rono Mollika ◽  
Shelina Begum ◽  
Md Harisul Hoque ◽  
Khandaker Nadia Afreen ◽  
Elora Sharmin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Airway Obstruction ◽  
Nyha Class ◽  
Class Ii ◽  
Left Ventricular ◽  
Small Airway ◽  
Class I ◽  
Ventilatory Function ◽  
Small Airway Obstruction

Background: Chronic heart failure (CHF) causes multiple lung complications and lung functions are reduced in CHF patients. Objective: To observe FVC, FEV1, FEV1/FVC% and their relationship with EF% in patients with chronic heart failure. Methods: This cross sectional study was conducted in the Department of Physiology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, during 2016. For this, 60 diagnosed stable male, aged 35-65 years CHF patients were randomly selected from the Cardiology Department of BSMMU, Dhaka. On the basis of staging of the disease (Stage C) and New York Heart Association (NYHA) functional classification, the study subjects were divided into two groups, 30 patients of NYHA Class- I and 30 patients of NYHA class –II. Thirty (30) apparently healthy Age, Sex and BMI matched subjects were taken as control. To assess the ventilatory function, Forced vital capacity (FVC), Forced expiratory volume in 1st  second (FEV1), Forced expiratory ratio (FEV1/FVC%) of all subjects were measured by a portable Digital Spirometer. Again, Ejection fraction (EF%) ranged (≥35% to ≤50%) were measured by Echocardiogram to observe left ventricular function of the heart. For statistical analysis, Independent sample‘t’ test and Pearson’s correlation co-efficient test was performed by using SPSS for windows version-16 & p≤0.05 was accepted as level of significance. Results: The mean percentage of predicted values of FVC and FEV1 were significantly lower but FEV1/FVC% was significantly higher in CHF patients comparison to the healthy control. All the study variables were significantly lower in patients of NYHA class–II as compared to patients of NYHA class–I. 73.33% CHF patients had restrictive, 10.00% small airway obstruction and 16.67% combined restrictive and small airway obstruction feature. In addition, FVC and FEV1 (p<0.05) was positively and FEV1/FVC% (p<0.05) negatively correlated with EF% in chronic heart failure patients. Conclusion: Left ventricular dysfunction may be silently associated with decrease ventilatory function mainly restrictive type of pulmonary disorder. University Heart Journal Vol. 16, No. 2, Jul 2020; 59-64

scholarly journals A Hybrid Procedure Combining Mini-Thoracotomy with Interventional Endocardial Lead Implantation for Cardiac Resynchronization Therapy in Patients with Chronic Congestive Heart Failure: A Report of Four Cases

2020 ◽  
Vol 23 (5) ◽  
pp. E627-E631
Author(s):  
Haiyan Xiang ◽  
Rifeng Gao ◽  
Juesheng Yang ◽  
Juxiang Li ◽  
Jin Li ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Nerve Stimulation ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Chronic Congestive Heart Failure ◽  
Electrode Impedance ◽  
Resynchronization Therapy ◽  
Mini Thoracotomy

Background: We describe the application and effectiveness of transthoracic electrode implantation for epicardial left ventricular pacing in cardiac resynchronization therapy (CRT) for patients with chronic congestive heart failure. Methods: We assessed four patients with chronic congestive heart failure for whom implantation of endocardial electrodes was contraindicated. The epicardial electrodes were implanted via a mini-thoracotomy in the fourth or fifth left intercostal space. We analyzed the surgical implantation technique and the short-term effectiveness of the procedure. Results: The epicardial electrodes successfully were implanted in all four patients. The patients’ hemodynamic status, cardiac function, and symptoms significantly improved. Patients I, II, III, and IV were discharged from the hospital on the 8, 11, 4, and 7 days, respectively, after the operation. Follow up lasted for 12 months. None of the patients presented with electrode fractures or surgical wound infections, and the pacing threshold and electrode impedance were normal. In one case, phrenic nerve stimulation occurred due to the low placement position of the electrode. When the electrode was moved slightly inward and upward, the sacral nerve stimulation sign disappeared, and no other complications were noted. One patient developed capsule infection, and the presence of an ectopic pacemaker was noted; therefore, a pacemaker replacement procedure was required. Conclusion: In CRT, the implantation of a left ventricular epicardial electrode through a left-sided small incision is safe, feasible, and effective. This hybrid surgery combining interventional and cardiac techniques can maximize the curative effect of CRT.

Sign in / Sign up

Export Citation Format

Share Document