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HEART FAILURE - CHRONIC
Heart failure is a clinical syndrome due to a structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood in order to deliver oxygen at a rate commensurate with the requirements of the metabolizing tissues.
Symptoms are caused by ventricular dysfunction secondary to abnormalities of the myocardium, pericardium, endocardium, valves, heart rhythm and conduction.
New onset heart failure refers to the first presentation of heart failure.
Transient heart failure refers to the symptomatic heart failure over a limited period of time although long-term therapy may be indicated.
Chronic heart failure is stable, worsening, or decompensated heart failure.

Prevention

Immunization

  • Pneumococcal vaccination and annual influenza vaccination are recommended in all patients with heart failure (HF) in the absence of known contraindication
  • Pulmonary congestion and pulmonary hypertension increase the risk of respiratory infections (one of the major causes of acute decompensation, especially in the elderly)

Counselling

  • Patient counseling tends to improve patient compliance and outcomes
  • Educate the patient and caregivers about chronic heart failure
    • Discuss the nature of heart failure (HF), treatment goals, drug regimens, dietary restrictions, symptoms of worsening HF, what to do if these symptoms occur and prognosis

Prognosis

  • Assessment of prognosis provides better information for the patients and their families to plan for their futures
  • Helps in the identification of patients in whom cardiac transplantation or mechanical device therapy should be considered

Conditions Associated with a Poor Prognosis in Heart Failure (HF)

  • Decreasing left ventricular ejection fraction (LVEF)
  • Worsening New York Heart Association (NYHA) functional status (Class III-IV)
  • Chronic hypotension
  • Widened QRS on 12-lead electrocardiogram (ECG)
  • Tachycardia and Q waves
  • Resting tachycardia
  • Left ventricular (LV) hypertrophy and complex ventricular arrhythmias
  • Marked elevation of brain-type natriuretic peptide (BNP)/N-terminal-pro-BNP (NT pro-BNP)
  • Elevated biomarkers of myocardial fibrosis (soluble ST2 receptor, galectin-3, high sensitivity cardiac troponin) and neurohormonal activation
  • Anemia
  • Hyponatremia
  • Decreasing peak exercise O2 uptake
  • Renal insufficiency or failure
  • Intolerance to therapy
  • Refractory volume overload
  • Advanced age
  • Ischemic etiology
  • Resuscitated sudden death
  • Prior HF hospitalization
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