Table 23 Most frequent causes of worsening heart failure Non-cardiac Non-compliance to the prescribed regimen(salt, liquid, medication) Recently co-prescribed drugs(anti-arrhythmics other than amiodarone, beta-blockers, NSAIDs, verapamil diltiazem) Infection Alcohol abuse Renal dysfunction (excessive use of diuretics Pulmonary embolism Hypertension Thyroid dysfunction(e.g amiodarone) Anaemia Cardiac Atrial fibrillation Other supraventricular or ventricular arrhythmias · Bradycardia Myocardial ischaemia(frequently symptomless), including myocardial infarction ppearance or worsening of mitral or tricuspid regurgitation Excessive preload reduction(e.g. due to diuretics+ACE- inhibitors/nitrates)
CARDIAC DYSFUNCTION NORMAL CORRECTED OR RESOLVED Therapy CAN be withdrawn Transient CARDIAC Ne Asymptomatic Heart cardiac without recurrence DYSFUNCTION Failure symptoms dysfunction of symptoms SYMPTOMS Therapy CANNOT Symptoms be withdrawn HEART Symptoms Systolic relieved without recurrence FAILURE per dysfunction of symptoms THERAPY Figure 1 Relationship between cardiac dysfunction, heart failure, and heart failure rendered asymptomatic
Suspected Lv dysfunction Suspected Heart Failure because of signs because of symptoms and signs Assess presence of cardiac disease by ECG, X-ray or Normal Heart Failure or lv dysfunction Natriuretic peptides where available) unlikely Tests abnorma Imaging by Echocardiography Normal (Nuclear angiography or Heart Failure or LV dysfunction MRI where available) unlikely Tests abnormal Assess aetiology, degree, precipitating factors and type of cardiac dysfunction Additional diagnostic tests where appropriate Choose therapy (e.g. coronary angiography) Figure 2 Algorithm for the diagnosis of heart failure or left ventricular dysfunction
心脏指数 正常 不也 也血 Lmm)①干小封实出 2.5 类大两升1 一心力衰 低 题小 0 6 12 18充血 左心室舒张末压(mmHg 其,常量用小 图3-2-1左心室功能曲线 表明在正常人和心力衰竭时左心室收缩功能(以心脏指数表示,为纵坐标)和左心 室前负荷(以左心室舒张末压表示,为横坐标)的关系。在心力衰竭时,心功能 曲线向右下偏移。当左心室舒张末压>18mmHg时,出现肺充血的症状和体征; 若心脏指数<22L(min·m2)时,出现低心排血量的症状和体征
Progression from hypertension to HF smoking dyslipidemia systolic diabetes MI dys- function heart HTN failure--death diastolic obesity LVH dys diabetes function normal LV subclinical clinical structure LV LV heart function remodeling dysfunction failure years years/months Adapted from Vasan RS, Levy D. Arch Inten Med 1996, 156(16): 1789 spot