المؤلفون: Clark, Andrew L., Cleland, John G.F.

المساهمون: Dwight, Jeremy

المصدر: Oxford Textbook of Medicine ; page C16.5.2-C16.5.2.P92

الوصف: Presentations of acute heart failure fall into three overlapping categories: acute breathlessness and pulmonary oedema; chronic fluid retention and peripheral oedema (anasarca); and cardiogenic shock. Features on examination include tachycardia, hypotension, a raised venous pressure, basal crackles, and peripheral oedema. Auscultation may reveal a third heart sound or features of valvular heart disease. Initial management focuses on confirming the diagnosis and identification of the immediate precipitant (e.g. arrhythmias, myocardial infarction, decompensating valvular heart disease). Initial investigations include a 12-lead electrocardiogram, chest radiograph, full blood count, biochemical screen, troponin, and thyroid function. Natriuretic peptides are useful in confirming the diagnosis where clinical features are present and a normal level of these is helpful in excluding the diagnosis. All patients should undergo echocardiographic assessment early in the course of a hospital admission to assess left ventricular function and to look for underlying valvular heart disease.

الإتاحة: https://doi.org/10.1093/med/9780198746690.003.0348Test
https://academic.oup.com/book/41095/chapter/351102542Test

المؤلفون: Cleland, John G.F., Clark, Andrew L.

المساهمون: Dwight, Jeremy

المصدر: Oxford Textbook of Medicine ; page C16.5.3-C16.5.3.P134

الوصف: Heart failure is a common clinical syndrome, predominantly a disease of older people, often presenting with breathlessness, fatigue, and peripheral oedema. Its pathophysiology is complex, with a common feature being salt and water retention, possibly triggered by a relative fall in renal perfusion pressure. Common aetiologies include ischaemic heart disease, hypertension, and valvular heart disease. New treatments have improved prognosis substantially over the past two decades. Early diagnosis relies on a low threshold of suspicion and screening of people at risk. Treatable causes for heart failure should be identified and corrected. Pharmacological therapy is given to improve symptoms and prognosis. Diuretic therapy is the mainstay for control of congestion and symptoms, but its effect on long-term prognosis is unknown. For patients with HFrEF, either angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor–neprilysin inhibitors, combined with β-blockers and mineralocorticoid receptor antagonists (triple therapy) provide both symptomatic and prognostic benefit.

الإتاحة: https://doi.org/10.1093/med/9780198746690.003.0349Test
https://academic.oup.com/book/41095/chapter/351102664Test