Heart Failure in Clinical Practice (eBook)

Foreword 5
Preface 6
Contents 7
Contributors 9
Definition, Diagnosis, Epidemiology, Etiology and Pathophysiology of Heart Failure 13
1.1 Definition of Heart Failure 13
1.2 Diagnosis and Investigations 15
1.3 Pathophysiology 22
1.4 Comorbidity 26
1.5 Exacerbating and Precipitating Factors 28
1.6 Monitoring of Organ Dysfunction and HF Severity 29
References 29
Inherited Myocardial Diseases 32
2.1 Introduction 32
2.2 Hypertrophic Cardiomyopathy 33
2.3 Dilated Cardiomyopathy 44
2.4 Arrhythmogenic Right Ventricular Cardiomyopathy 55
References 66
Valvular Heart Disease in Heart Failure 88
3.1 Aortic Valve Disease 88
3.2 Mitral Valve Disease 99
3.3 Tricuspid Valve Disease 106
3.4 Pulmonary Valve Disease 108
References 108
Congenital Heart Disease 115
4.1 Heart Failure and Adult Congenital Heart Disease 115
4.2 Quantification and Follow-Up of Exercise Intolerance 116
4.3 Mechanisms of Heart Failure in ACHD 120
4.4 Systemic Effects of the Heart Failure Syndrome in ACHD 122
4.5 Controversial Issues in the Care of ACHD Patients: The Heart Failure Perspective 123
References 127
Heart Failure with a Normal Ejection Fraction 132
5.1 Epidemiology 132
5.2 Diagnosis of HFNEF 133
5.3 Assessment of Diastolic Dysfunction and LV Filling Pressures 134
5.4 Pathophysiology of HFNEF 136
5.5 Twist, Annular Motion and Myocardial Architecture 137
5.6 Other Peripheral Factors 139
5.7 Dyssynchrony 139
5.8 Metabolic Abnormalities in HFNEF 140
5.9 Evolution of HFNEF into HFREF 141
References 143
Right Heart Failure 147
6.1 Right Ventricular Anatomy and Physiology 147
6.2 Ventricular Interaction 148
6.3 Right Ventricular Dysfunction in Left Ventricular Failure 149
6.4 Assessment of Right Ventricular Dysfunction 150
6.5 Treatment of Right Ventricular Dysfunction in Patients with Left Ventricular Disease 152
6.6 Cardiopulmonary Bypass Circulation and the Right Ventricle 154
6.7 Right Ventricular Dysfunction Secondary to Pulmonary Disease 155
6.8 Primary Right Ventricular Dysfunction 155
6.9 Prognostic Value of Right Ventricular Function 156
References 157
Pulmonary Arterial Hypertension 160
7.1 Classification 160
7.2 Definition and Pathophysiology 162
7.3 Pulmonary Hypertension and the Right Heart 162
7.4 Endothelin Receptors Blockers 167
7.5 Phosphodiesterase-5 Inhibitors 168
7.6 Prostanoids 168
7.7 Thromboendarterectomy 169
References 170
Cardiac Cachexia in Chronic Heart Failure: The Metabolic Facet of CHF 171
8.1 Introduction 171
8.2 Body Composition in Chronic Heart Failure: The Obesity Paradox 172
8.3 Definition of Cachexia 173
8.4 Mechanisms of Altered Body Composition 175
8.5 Tissue Degradation 180
8.6 Therapeutic Options 182
8.7 Metabolic Effects of State of the Art CHF Medical Therapies 182
8.8 Specific Nutritional Considerations in Cardiac Cachexia 184
8.9 Potential Novel Therapies with Specific Metabolically Targeted Intervention 184
8.10 Conclusion 185
References 186
Breathing Disturbances in Heart Failure 192
9.1 Pulmonary Abnormalities in Heart Failure 192
9.2 Exercise Ventilatory Abnormalities in Heart Failure 193
9.3 Exercise Testing 193
9.4 Chemoreceptors: The ventilatory Response to Changes in Arterial CO 195
9.5 Unstable Ventilatory Patterns/Sleep Apnoea in Heart Failure 196
9.6 Diagnosis of CSA 197
9.7 Prevalence of CSA 198
9.8 Pathophysiology of Periodic Breathing 199
9.9 CSA and Mortality 201
9.10 Treatment of CSA 202
9.11 Periodic Breathing During Exercise 203
9.12 Conclusion 203
References 203
Stress Echocardiography 209
10.1 Incipient or Latent Cardiomyopathy 211
10.2 Dilated Cardiomyopathy 212
10.3 Differentiation Between Ischemic and Nonischemic Dilated Cardiomyopathy 214
10.4 Stress Echo and CRT 215
References 219
Echocardiography in Heart Failure 222
11.1 Resting Echocardiography 222
11.2 Echocardiography in Resistant Fluid Retention 227
11.3 Stress Echocardiography 227
References 230
Cardiac Radionuclide Imaging in the Assessment of Patients with Heart Failure 233
12.1 Positron Emission Tomography 234
12.2 Single Photon Emission Computed Tomography Tracers 235
12.3 Assessment of Cardiac Neuronal Function 236
12.4 Myocardial Fatty Acid Metabolism 237
12.5 Other Applications of Radionuclide Imaging in Heart Failure 238
12.6 Radionuclide Ventriculography 238
12.7 Conclusion 239
References 239
Cardiovascular Magnetic Resonance in Heart Failure 242
13.1 Introduction 242
13.2 Ventricular Function 243
13.3 Viability and Coronary Arteries 244
13.4 Perfusion 244
13.5 Dilated Cardiomyopathy 244
13.6 Cardiac Resynchronization Therapy 245
13.7 Hypertrophic Cardiomyopathy 246
13.8 Valvular Heart Disease 246
13.9 Sarcoidosis 247
13.10 Amyloidosis 248
13.11 Myocarditis 248
13.12 Peripatum Cardiomyopathy 249
13.13 Pulmonary Arterial Hypertension 250
13.14 Congenital Heart Disease 250
13.15 Contraindications/Limitations of CMR 251
References 252
Principles of Treatment and Pharmacotherapy 255
14.1 Principles of Modern Heart Failure Treatment 256
14.2 Pharmacotherapy 266
References 272
Nonpharmacological Therapies 276
15.1 Introduction 276
15.2 Patient and Care Education 277
15.3 Diet and Nutrition 278
15.4 Psychological Support 279
15.5 Sleep Disorders 280
15.6 Specialist Heart Failure Clinics and Nurses 280
15.7 Exercise Training 281
15.8 Questions and Controversies 284
References 285
Atrial Fibrillation and Heart Failure Syndromes 288
16.1 Epidemiology 289
16.2 Pathophysiology 291
16.3 Management 293
16.4 Nonpharmacologic Therapies 296
16.5 Problem Areas 299
16.6 Summary 302
References 303
Natriuretic Peptides 308
17.1 Introduction 308
17.2 Natriuretic Peptides 308
17.3 Physiology of BNP 309
17.4 Clinical Usefulness 310
17.5 Cost-Effectiveness 313
17.6 Kidneys and BNP/NTproBNP 313
17.7 Other Pitfalls and Controversies 314
References 315
Cardiac Resynchronization Therapy 318
18.1 Clinical Benefits of CRT 318
18.2 Cardiac Structural and Functional Benefits of CRT 319
18.3 Other Benefits of CRT 323
18.4 CRT Device Based Diagnostics for Monitoring of HF Decompensation 323
18.5 Evolving and Potentially New Indications of CRT 327
References 330
Device Therapy in Heart Failure 335
19.1 Introduction 335
19.2 The Implantable Cardiodefibrillator (ICD) 336
19.3 Cardiac Resynchronization Therapy (CRT) 340
19.4 Combined Resynchronization and Defibrillation Devices (CRTD) 341
19.5 Nonresponders to CRT 343
19.6 Patients in Atrial Fibrillation 346
19.7 Patients with Heart Failure and a Traditional Indication for Right Ventricular Pacing 346
19.8 Optimization of CRT 347
19.9 Summary 348
References 348
The Role of Surgery in Heart Failure 351
20.1 Introduction 351
20.2 Revascularization of Hibernating Myocardium 351
20.3 Ventricular Restoration 354
20.4 Mitral Valve Surgery 357
20.5 Left Ventricular Assist Devices 359
20.6 Heart Transplantation 363
References 364
Index 368