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| ===== Heart catheterization ===== | | ===== Heart catheterization ===== |
| Heart catheterization is not part of the routine diagnosis and work-up of patients with HF. But in patients suffering angina pectoris despite optimal medical therapy, it should be considered (Class of recommendation IIa, level of evidence C, see table 4). Also, coronary angiography is recommended in patients at high risk of coronary artery disease (Class of recommendation I, level of evidence C) and in HF patients with significant valvular disease (Class of recommendation IIa, level of evidence C). | | Heart catheterization is not part of the routine diagnosis and work-up of patients with HF. But in patients suffering angina pectoris despite optimal medical therapy, it should be considered (Class of recommendation IIa, level of evidence C, see Table 4). Also, coronary angiography is recommended in patients at high risk of coronary artery disease (Class of recommendation I, level of evidence C) and in HF patients with significant valvular disease (Class of recommendation IIa, level of evidence C). |
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| Table 3 Common echocardiographic abnormalities in heart failure
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| Measurement Abnormality Clinical implications
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| LVEF Reduced (<45 – 50%) Systolic dysfunction
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| LV ejection fraction Akinesis, hypokinesis, dyskinesis Myocardial infarction/ischaemia, cardiomyopathy, myocarditis
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| End-diastolic diameter Increased (>55 – 60 mm) Volume overload
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| HF likely
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| End-systolic diameter Increased (>45 mm) Volume overload
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| HF likely
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| Fractional shortening Reduced (<25%) Systolic dysfunction
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| Left atrial size Increased (>40 mm) Increased filling pressures, mitral valve dysfunction, atrial fibrillation
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| Left ventricular thickness Hypertrophy (>11 – 12 mm) Hypertention, aortic stenosis, hypertrophic cardiomyopathy
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| Valvular structure and function Valvular stenosis or regurgitation (especially aortic stenosis and mitral insufficiency) May be primary cause of HF or complicating factor
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| Asses haemodynamic consequences
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| Consider surgery
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| Mitral diastolic flow profile Abnormalities of the early and late diastolic filling patterns Indicates diastolic dysfunction and suggests mechanism
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| Tricuspid regurgitation peak velocity Increased (>3 m/s) Increased right ventricular systolic pressure
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| Suspect pulmonary hypertention
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| Pericardium Effusion, haemopericardium, thickening Consider tamponade, uraemia, malignancy, systemic disease, acute or chronic pericarditis, contrictive pericarditis
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| Aortic outflow velocity time integral Reduced (<15 cm) Reduced low stroke volume
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| Inferior vena cava Dilated retrograde flow Increased right atrial pressures, right ventricular dysfunction, hepatic congestion
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| == Management == | | == Management == |