DIAGNOSIS AND TREATMENT OF HEART FAILURE

TABLE OF CONTENTS
(translated from Russian)

Introduction 10
Chapter I. Etiology and pathogenesis of heart failure 12
Definition of "heart failure" 12
Main causes of congestive heart failure (CHF) 14
Major underlying clinical pathology in development of CHF 16
Medications that may impair cardiac function 17
Precipitating factors in heart failure 18
Pathogenesis of heart failure 20
Molecular mechanisms of cardiomyocyte dysfunction 22
Compensatory changes in heart failure 23
Correlation between pathophysiologic changes and symptoms of CHF 26
Pathophysiologic mechanisms and clinical presentation in heart failure 27
Chapter II. Diagnosis and classification of congestive heart failure 29
Suggestive signs and symptoms 29
Physical evaluation 30
Third heart sound (gallop): where and how to listen? 34
Assessment plan 36
Electrocardiographic findings in patients with heart failure 37
Recommended tests for patients with CHF 39
Echocardiography and radionuclide ventriculography compared in evaluation of
left-ventrivular function		 41
Clinical presentation of right heart failure 43
Major causes of right heart failure 44
Classification of heart failure by V.H. Vasilenko and M.D. Strazhesko 45
NYHA functional classification 46
Classification of heart failure by objective criteria 47
Determining the severity of heart failure by objective criteria 48
Chapter III. Management of congestive heart failure (general principles) 50
Strategy of CHF management 50
Tactics of CHF management 51
Non-pharmacological treatment of CHF 53
Hospitalization and discharge of heart failure patients 56
Suggested topics for patient and family education in CHF 57
Chapter IV. Pharmacological management of congestive heart failure 59
Diuretics 61
Diuretics commonly used for heart failure 64
Vasodilators 68
Cassification of oral vasodilators and their use in CHF 68
Pharmacokinetics of nitrates 70
Nitrate dosage in patients with CHF 71
ACE-inhibitors 73
Traditional views on renin-angiotensin-aldosterone system 74
Physiologic role of angiotensin II 75
Types of receptor to angiotensin II 76
Dosage of ACE-inhibitors in CHF 77
Drug interactions with ACE-inhibitors 78
Modern understanding of angiotensin II synthesis in tissues 79
Role of angiotensin II receptor blockade in treatment of CHF 80
Cardiac glycosides 81
Mechanism of action of cardiac glycosides 81
Clinical pharmacology of cardiac glycosides 84
Pharmacological properties of cardiac glycosides 85
Pharmacokinetics of cardiac glycosides 87
Digitalis toxicity 89
Factors affecting myocardial sensetivity to digitalis 90
Electrocardiogram changes in patients taking cardiac glycosides 92
Treatment of digitalis toxicity 95
Drug interactions with cardiac glycosides 96
Antiarrhythmic therapy in patinets with CHF 98
Beta-blockers 100
Classification of beta-blockers 102
Drug interactions with beta-blockers 107
New trends in the treatment of CHF 108
Chapter V. Surgical treatment of severe heart failure 110
Heart transplantation 110
Technique for orthotopic heart transplantation 112
Artificial heart 114
Implantation of left ventricular assist device 115
Dynamic cardiomyoplasty 116
Role of coronary bypass grafting 118
Chapter VI. Diagnosis and management of acute heart failure 120
Major causes of acute heart failure 120
Major precipitating factors for decompensation of chronic heart failure 121
Clinical picture of pulmonary edema 122
Diagnosis of pulmonary edema 123
Treatment of pulmonary edema 124
Principal pharmacological properties of major sympathomimetic amines 130
Pharmacological features of major sympathomimetic amines 131
Initial diagnostic evaluation of cardiogenic shock/near shock 133
Therapeutic management of cardiogenic shock/near shock 136
Recommendations for intra-aortic balloon counterpulsation in heart failure 141
Chapter VII. Clinical use of intra-aortic balloon pumping (IABP) 143
Theory of IABP 144
Timing 151
Indications for IABP 152
Contraindications for IABP 152
Complications of IABP 155
Suggestions to ensure effective IABP 156
Self-assessment questions 157
Appendix. Major clinical trials in the treatment of CHF 158
Bibliography 188
List of slides 201

     © V. Kryzhanovski, 1996

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