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===Heart catheterization=== | ===Heart catheterization=== | ||
Heart catheterization is not always part of the routine diagnosis and work-up of patients with HF. It should be considered however to exclude coronary heart disease (Class of recommendation IIa, level of evidence C, see Table 4). 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 always part of the routine diagnosis and work-up of patients with HF. It should be considered however to exclude coronary heart disease (Class of recommendation IIa, level of evidence C, see [[Heart_Failure_Table_4|Table 4]]). 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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==Etiology of heart failure== | ==Etiology of heart failure== | ||
===Coronary heart disease=== | ===Coronary heart disease=== | ||
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Deficiency of thiamine, selenium, or camitine, in states of severe cachexia. | Deficiency of thiamine, selenium, or camitine, in states of severe cachexia. | ||
Infiltrative and storage disorders | ===Infiltrative and storage disorders=== | ||
*Sarcoidosis | *[[Sarcoidosis]] | ||
*Amyloidosis | *[[Amyloidosis]] | ||
*Haemochromatosis | *[[Haemochromatosis]] | ||
*Connective tissue disease | *Connective tissue disease | ||
===Infectious disease=== | ===Infectious disease=== | ||
*Chagas’ disease | *[[Chagas’ disease]] | ||
*HIV infection | *[[HIV infection]] | ||
*Viral, bacterial or protozoal diseases causing myocarditis. | *Viral, bacterial or protozoal diseases causing myocarditis. | ||
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|bgcolor="99FFCC" align="center"|'''Aldosteron antagonist''' | |bgcolor="99FFCC" align="center"|'''Aldosteron antagonist''' | ||
|bgcolor="99FFCC"| | |bgcolor="99FFCC"| | ||
|bgcolor="9ACD32" align="center"|'''EF | |bgcolor="9ACD32" align="center"|'''EF < 35%''' | ||
|bgcolor="9ACD32" align="center"|'''EF | |bgcolor="9ACD32" align="center"|'''EF < 35%''' | ||
|bgcolor="9ACD32" align="center"|'''EF | |bgcolor="9ACD32" align="center"|'''EF < 35%''' | ||
|- | |- | ||
|bgcolor="99FFCC" align="center"|'''Nitrate / Hydralazine''' | |bgcolor="99FFCC" align="center"|'''Nitrate / Hydralazine''' | ||
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|bgcolor="9ACD32" align="center"|'''Afro-American''' | |bgcolor="9ACD32" align="center"|'''Afro-American''' | ||
|bgcolor="9ACD32" align="center"|'''Afro-American''' | |bgcolor="9ACD32" align="center"|'''Afro-American''' | ||
|- | |||
|bgcolor="99FFCC" align="center"|'''Ivabradine''' | |||
|bgcolor="99FFCC"| | |||
|bgcolor="9ACD32" align="center"|'''SR>75/min & EF<35%''' | |||
|bgcolor="9ACD32" align="center"|'''SR>75/min & EF<35%''' | |||
|bgcolor="9ACD32" align="center"|'''SR>75/min & EF<35%''' | |||
|- | |- | ||
|bgcolor="99FFCC" align="center"|'''Digoxin''' | |bgcolor="99FFCC" align="center"|'''Digoxin''' | ||
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===Angiotensin-converting enzyme (ACE) inhibitors=== | ===Angiotensin-converting enzyme (ACE) inhibitors=== | ||
An ACE inhibitor | An ACE inhibitor is indicated for every patient with symptomatic systolic HF and an EF ≤40 % (NYHA class II-IV). (Class I recommendation, level of evidence A) Contraindications for the use of ACE inhibitors are: | ||
*History of angioedema | *History of angioedema | ||
*Bilateral renal artery stenosis | *Bilateral renal artery stenosis | ||
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==Therapy of acute heart failure== | ==Therapy of acute heart failure== | ||
[[Image:acute_hf_flowchart.svg|400px|thumb|'''Figure 7.''' Flowchart acute HF.]] | |||
When severe symptoms of heart failure quickly develop over time, it is termed acute heart failure. In Table 6, common acute HF medications and their recommended doses are summarized. In Figure 7, a flowchart for the treatment of acute HF is depicted. The mainstay of acute heart failure therapy includes diuretics, vasodilators, inotropics and vasopressors. Moreover, oxygen and morphine can be added. | When severe symptoms of heart failure quickly develop over time, it is termed acute heart failure. In Table 6, common acute HF medications and their recommended doses are summarized. In Figure 7, a flowchart for the treatment of acute HF is depicted. The mainstay of acute heart failure therapy includes diuretics, vasodilators, inotropics and vasopressors. Moreover, oxygen and morphine can be added. | ||
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|- | |- | ||
|'''Diuretics''' | |'''Diuretics''' | ||
|Adequate blood pressure and signs of overfilling | |colspan="2"|Adequate blood pressure and signs of overfilling | ||
|- | |- | ||
| | | | ||
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Renal failure | Renal failure | ||
|40 mg | |40 mg | ||
125 mg – max 1000 mg | |||
|- | |- | ||
| | | | ||
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Renal failure | Renal failure | ||
|1 mg | |1 mg | ||
3 mg – max 25 mg | |||
|- | |- | ||
|'''Vasodilators''' | |'''Vasodilators''' | ||
|Adequate blood pressure and signs of severe overfilling | |colspan="2"|Adequate blood pressure and signs of severe overfilling | ||
|- | |||
| | | | ||
*Nitroglycerine i.v. | *Nitroglycerine i.v. | ||
| | | | ||
|20 µg/min – max 200 µg/min (guided by blood pressure) | |20 µg/min – max 200 µg/min (guided by blood pressure) | ||
|- | |||
| | | | ||
*Nitroprusside i.v. | *Nitroprusside i.v. | ||
| | ||Hypertensive crisis or in combination with inotropic in case of a cardiogenic shock | ||
|Hypertensive crisis or in combination with inotropic in case of a cardiogenic shock | |||
|0.3 µg/kg/min – max 5 µg/kg/min (guided by blood pressure) | |0.3 µg/kg/min – max 5 µg/kg/min (guided by blood pressure) | ||
|- | |- | ||
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|- | |- | ||
|valign="top"| | |valign="top"| | ||
*Lisinopril | *Lisinopril | ||
| | | | ||
|Start 2.5-5mg | |Start 2.5-5mg | ||
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*Valsartan | *Valsartan | ||
| | | | ||
|Start | |Start 40mg twice daily | ||
3-5 weeks | 3-5 weeks 80mg twice daily. | ||
>7 weeks | >7 weeks 160mg twice daily. | ||
|- | |- | ||
|colspan="3" bgcolor="#F0F0F0 "|'''Hydralazine and isosorbide dinitrate (H-ISDN)''' | |colspan="3" bgcolor="#F0F0F0 "|'''Hydralazine and isosorbide dinitrate (H-ISDN)''' |