Chronic Heart Failure

Prof. Dr. med. Erland Erdmann ist Direktor der Klinik III für Innere Medizin (Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin) am Klinikum der Universität zu KölnTagungspräsident des Kardiologenkongresses 04/2003 -2007; mit dem Bundesverdienstkreuz 1. Klasse ausgezeichnet

1 Definition.- 2 Epidemiology.- 3 Normal and Pathological Anatomy.- 4 Pathophysiology.- 4.1 Molecular Mechanisms of Contraction.- 4.2 Regulation of the Contractile Force.- 4.3 Compensatory Mechanisms.- 4.4 Determinants and Assessment of the Cardiac Function.- 4.5 Blood Supply of the Organs and Cardiac Output Capacity.- 4.6 Musculoskeletal Metabolism in Heart Failure.- 4.7 Vascular periphery in Heart Failure.- 4.8 Pathogenesis of Cardiac Oedema.- 5 Clinical Course and Symptomatology.- 5.1 Forward and Backward Failure.- 5.2 Systolic and Diastolic Heart Failure.- 5.3 Low-Output and High-Output Heart Failure.- 5.4 Acute and Chronic Heart Failure.- 5.5 Classification Criteria for Heart Failure (Revised NYHA Classification).- 6 Diagnosis and Differential Diagnosis of Heart Failure.- 6.1 Principles of Diagnosis.- 6.2 Diagnostic Procedures, Overview.- 6.3 History.- 6.4 Physical Examination.- 6.5 ECG.- 6.6 Radiological Examination of the Thorax.- 6.7 Echocardiography and Doppler Echocardiography.- 6.8 Heart Catheterization.- 6.9 Myocardial Biopsy.- 6.10 Computed Tomography.- 6.11 Nuclear Spin Tomography.- 6.12 Nuclear Medicine Procedures.- 6.13 New Haemodynamic Monitoring Methods.- 6.14 Conclusions.- 7 Principles of Therapy.- 7.1 General and Specific Therapy.- 7.2 Aims of Therapy.- 8 Therapy with Cardiac Glycosides.- 8.1 Mechanism of Action.- 8.2 Pharmacokinetics.- 8.3 Pharmacodynamics.- 8.4 Age-Dependent Regulation of the Cardiac Glycoside Receptors.- 8.5 Effect on the Failing Myocardium.- 8.6 Interaction of Drugs with Digitalis.- 8.7 Measurement of the Digitalis Concentration in the Blood.- 8.8 Cardiac Glycosides in Atrial Fibrillation and Flutter.- 8.9 Cardiac Glycosides in Sinus Tachycardia and Paroxysmal Atrial Fibrillation.- 8.10 Cardiac Glycosides in Acute Heart Failure.-8.11 Cardiac Glycosides in Myocardial Infarction.- 8.12 Cardiac Glycosides in Chronic Heart Failure.- 8.13 Lacking Indication for Digitalis.- 8.14 Choosing the Cardiac Glycoside.- 8.15 Dosage of Digoxin and its Derivates.- 8.16 Side Effects and Intoxication.- 8.17 Therapy of Cardiac Glycoside Intoxication.- 8.18 Contraindications for Cardiac Glycosides.- 9 Therapy with Diuretics.- 9.1 Classification According to the Site of Action.- 9.2 Classification According to Potency.- 9.3 Side Effects of Diuretic Therapy.- 9.4 Other Fluid Liquid Extraction Methods.- 9.10 General Hypokalaemia.- 10 Therapy with ACE Inhibitors.- 10.1 Pharmacodynamics.- 10.2 Pharmacokinetics.- 10.3 Established Indications.- 10.4 Effects on Left Ventricular Dilatation.- 10.5 Dosage.- 10.6 Choosing the right ACE Inhibitor.- 10.7 Side Effects:.- 10.8 Interaction with Other Drugs.- 10.9 Contraindications.- 10.10 Treatment with Other Vasodilators.- 11 Therapy with Other Drugs.- 11.1 Calcium Antagonists.- 11.2 Inodilators (cAMP Phosphodiesterase Inhibitors).- 11.3 Catecholamines.- 11.4 ?-Receptor Blockers.- 11.5 Experimental Therapies.- 11.6 Antiarrhythmic Therapy in Cases of Heart Failure.- 11.7 Pacemaker Therapy.- 11.8 Surgical Therapy of Heart Failure (Cardiomyoplasty).- 11.9 Anticoagulation.- 11.10 Acutely Deteriorated and Therapy-Resistant Heart Failure.- 12 Mechanical Circulatory Support.- 12.1 Indications and Contraindications.- 12.2 Methods.- 12.3 Prognosis.- 13 The Ageing Heart.- 13.1 Ageing and Physical Strain.- 13.2 Morphological Changes.- 13.3 Functional Changes.- 13.4 Cardiac Regulation in the Elderly under Strain.- 13.5 Cardiac Diseases in the Elderly.- 13.6 Summary and Conclusions.- 14 Aspects of Altered Gene Expression in Heart Failure and Myocardial Hypertrophy.- 14.1 Examination of theProtein Biosynthesis and Gene Expression.- 14.2 Structure and Function of the Contractile Apparatus.- 14.3 Contractile Apparatus in Cardiac Hypertrophy and Heart Failure.- 14.4 Intracellular Calcium Homeostasis.- 14.5 Signal Transduction in the Cell Membrane.- 14.6 Clinical Consequences.- References.