Heart Failure

Heart failure is a clinical syndrome caused by structural or functional impairment of ventricular filling or ejection. Dyspnea, fatigue, congestion, and edema are common but nonspecific; no single diagnostic test is sufficient. A prior low EF without clinical evidence of heart failure should not be equated with heart failure. AHA Journals+1AHA Journals2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure)PubMedDiagnosing heart failure - Chronic Heart Failure in Adults - NCBI Bookshelf

Initial assessment should establish acuity, congestion versus hypoperfusion, blood pressure, rhythm, ischemic symptoms, valve disease, renal and hepatic dysfunction, and competing cardiopulmonary diagnoses. Obtain ECG, chest radiography when clinically useful, CBC, renal function and electrolytes, liver tests, thyroid testing, glycemic assessment, and transthoracic echocardiography to evaluate ventricular systolic and diastolic function, valves, chamber size, and shunts. PubMedPubMedDiagnosing heart failure - Chronic Heart Failure in Adults - NCBI Bookshelf

Classify by LVEF: HFrEF at 40% or less, HFmrEF above 40% to below 50%, HFpEF at 50% or greater, and HF with recovered EF when a previously reduced EF improves to at least 50%. These categories guide evidence application but do not define etiology or filling pressures. AHA JournalsAHA Journals2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure)

The supplied U.S. heart failure guideline is the principal source for patient-centered prevention, diagnosis, and management recommendations, but detailed drug dose tables are not available in the provided search excerpts. Therefore, this review names core medication classes without adding unsupported dose or titration schedules. AHA JournalsAHA Journals2022 AHA/ACC/HFSA Guideline for the Management of ...

In HFrEF, foundational therapy includes renin-angiotensin system modulation with an ARNI or other appropriate RAAS-directed therapy, an evidence-based beta blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor. The 2022 AHA/ACC/HFSA guideline is the key U.S. reference for selection, sequencing, eligibility, and monitoring. AHA JournalsAHA Journals2022 AHA/ACC/HFSA Guideline for the Management of ...

Sacubitril/valsartan is FDA-indicated to reduce cardiovascular death and heart failure hospitalization in adults with chronic heart failure, with benefit most clearly evident when LVEF is below normal. The usual adult starting dose is 49/51 mg orally twice daily, titrated every 2 to 4 weeks as tolerated to 97/103 mg twice daily; begin at half the usual starting dose for severe renal impairment, moderate hepatic impairment, or no/low prior ACE inhibitor or ARB exposure. Do not coadminister with an ACE inhibitor; allow a 36-hour washout when switching from an ACE inhibitor. accessdata fdaaccessdata fdaENTRESTO® (sacubitril and valsartan) tablets, for oral use ...

Metoprolol succinate is FDA-indicated for stable symptomatic NYHA II or III heart failure. Start 25 mg once daily for 2 weeks in NYHA II or 12.5 mg once daily in more severe heart failure, then double every 2 weeks to the highest tolerated dose or 200 mg daily. Stabilize other heart failure therapy first; with transient worsening heart failure, intensify diuresis and restore clinical stability before further titration. Avoid abrupt discontinuation. accessdata fdaaccessdata fdaMetoprolol succinate - accessdata.fda.gov

In obstructive hypertrophic cardiomyopathy, dynamic outflow obstruction is sensitive to preload, afterload, and contractility. A peak LVOT gradient of at least 30 mm Hg defines obstruction; resting or provoked gradients of at least 50 mm Hg are generally considered capable of causing symptoms and are the threshold for advanced pharmacologic or invasive strategies when symptoms are refractory. AHA JournalsAHA Journals2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for ...

For symptomatic obstructive hypertrophic cardiomyopathy, nonvasodilating beta blockers are first-line. Verapamil or diltiazem are alternatives. Persistent symptoms despite first-line therapy may prompt consideration of a cardiac myosin inhibitor in adults, disopyramide with an AV nodal blocking agent, or septal reduction therapy at an experienced HCM center. AHA JournalsAHA Journals2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for ...

Avoid or reconsider pure vasodilators, high-dose diuretics, and positive inotropes in symptomatic obstructive hypertrophic cardiomyopathy because reduced preload or afterload and increased contractility can worsen obstruction. Low-dose diuretics may be used cautiously for persistent congestive symptoms. AHA JournalsAHA Journals2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for ...

Follow-up should include symptoms, NYHA class, blood pressure, heart rate and rhythm, weight and volume status, renal function, electrolytes, medication tolerance, and adherence. Heart failure data standards also identify functional assessment, patient-reported outcomes, cardiopulmonary exercise testing, rhythm monitoring, and invasive hemodynamics as appropriate tools in selected patients. AHA JournalsAHA Journals2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure)

In hypertrophic cardiomyopathy, serial transthoracic echocardiography every 1 to 2 years in asymptomatic patients can assess changes in systolic and diastolic function, wall thickness, chamber size, LVOT obstruction, and valvular disease. Ambulatory ECG monitoring every 1 to 2 years is reasonable for arrhythmia surveillance in patients without ICDs. AHA JournalsAHA Journals2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for ...

Advanced heart failure develops in an estimated 3% to 8% of patients with hypertrophic cardiomyopathy. Refer for transplant evaluation when severe symptoms or recurrent ventricular arrhythmias persist despite optimized medical therapy and septal reduction is not an option; preserved EF does not exclude advanced restrictive physiology or transplant candidacy. AHA JournalsAHA Journals2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for ...