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Drug & Device Selection in Heart Failure
Prakash C Deedwania, Paul J Mather
CHAPTER 1:
Renewed Understanding of the Pathophysiology of Heart Failure
INTRODUCTION
INCIDENCE, PREVALENCE, AND RISK FACTORS
COST OF MANAGEMENT
PATHOPHYSIOLOGY OF HEART FAILURE
Morphologic Changes in Systolic and Diastolic Heart Failure
Hemodynamic Abnormalities in Systolic and Diastolic Abnormalities
Functional Changes in Systolic and Diastolic Heart Failure
Myocyte and Myocardial Structure in Systolic and Diastolic Heart Failure
Neurohormonal Changes in Systolic and Diastolic Heart Failure
CONCLUSIONS
CHAPTER 2:
New Diuretics in Heart Failure
INTRODUCTION
MECHANISM OF ACTION
PHARMACOKINETICS
PHARMACODYNAMICS
DOSING
DIURETICS IN RENAL AND LIVER DISEASE
INTRAVENOUS THERAPY
BOLUS VERSUS CONTINUOUS DOSING
COMBINATION THERAPY
ADVERSE EFFECTS
DIURETIC RESISTANCE
CARDIORENAL SYNDROME
VAPTANS
ADENOSINE RECEPTOR ANTAGONIST
GUIDELINES
CONCLUSION
CHAPTER 3:
Guideline Based Standard Therapy for Heart Failure: The Role of RAAS Blockers and Beta Blockers
INTRODUCTION
GUIDELINE-BASED THERAPY FOR HEART FAILURE
RENIN ANGIOTENSIN ALDOSTERONE SYSTEM BLOCKING DRUGS
Angiotensin-Converting Enzyme Inhibitors
Practical Considerations Regarding Use of Angiotensin-Converting Enzyme Inhibitors
Safety and Adverse Effects of Angiotensin-Converting Enzyme Inhibitors
Hypotension
Cough
Renal Dysfunction
Hyperkalemia
Angioedema
Angiotensin Receptor Blockers
Practical Considerations Regarding Use of ARBs
BETA ADRENERGIC BLOCKERS
Practical Considerations
Helpful Hints Regarding Use of Beta Blockers in Heart Failure
Safety and Adverse Experience
CLINICAL APPLICATION OF GUIDELINE-BASED THERAPY
CHAPTER 4:
Emerging Role of Aldosterone Receptor Blockers in Heart Failure
INTRODUCTION
BASIC CONCEPT OF RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM AND CARDIOVASCULAR HEMODYNAMICS
ROLE OF ALDOSTERONE IN CARDIOVASCULAR DISEASE AND HEART FAILURE
ROLE OF ALDOSTERONE ANTAGONISTS IN HEART FAILURE
CLINICAL TRIALS WITH ALDOSTERONE RECEPTORS ANTAGONISTS IN HEART FAILURE
CURRENT EVIDENCE-BASED GUIDELINES FOR ALDOSTERONE BLOCKING DRUGS
CLINICAL UTILIZATION OF ALDOSTERONE RECEPTOR ANTAGONIST IN HEART FAILURE
FUTURE PERSPECTIVES ABOUT ALDOSTERONE ANTAGONISTS IN HEART FAILURE MANAGEMENT
CHAPTER 5:
Inotropic Therapy for Heart Failure: Past, Present, and Future
INTRODUCTION
POTENTIAL MECHANISTIC BENEFITS AND RISKS
THE PAST: THE RISE AND FALL OF ORAL INOTROPES
The Drugs
Pimobendan
Vesnarinone
Enoximone
Levosimendan
Istaroxime
Possible Explanations for the Failure of oral Inotropic Agents
THE PRESENT: CURRENT PRACTICE
Acute Decompensated Heart Failure
Clinical Setting
Dopamine
Dobutamine
Milrinone
Guidelines
Chronic Symptomatic Heart Failure
Other Settings
Bridge to Beta blockade
Bridge to Transplant or Ventricular Assist Device
Postcardiotomy Syndrome
Right Ventricular Support
Palliation with Intravenous Inotropic Agents
FUTURE DEVELOPMENT OF INOTROPIC DRUGS
Omecamtiv Mecarbil: A Novel Drug
New Indications: Palliation with Oral Inotropic Drugs
Looking Forward
CHAPTER 6:
Hospitalization for Heart Failure: Pathophysiology, Classification, and Management Considerations
INTRODUCTION
PATHOPHYSIOLOGY
Clinical Course and Definition of Congestion
Identifying Hemodynamic Congestion
Consequences of Congestion
Neurohormonal Abnormalities
PHENOTYPICAL CLASSIFICATION OF HEART FAILURE
Preserved versus Reduced Ejection Fraction
De Novo versus Worsening Chronic Heart Failure
Low Systolic Blood Pressure
Myocardial Ischemia and Coronary Artery Disease
Renal Dysfunction and Worsening Renal Function
Select Cardiac Comorbidities
Valves
Electrical System
Myocardium
Vascular
Pericardium
Metabolic Needs
Select Noncardiac Comorbidities
CONCLUSIONS
ACKNOWLEDGMENTS
FUNDING
CHAPTER 7:
Traditional Mechanical Support
VENTRICULAR ASSIST DEVICES FOR INTERMEDIATE OR LONG-TERM USE
Pulsatile-Flow Devices
Axial-Flow Devices
HeartMate II
Jarvik 2000
Complications of Axial-Flow Left Ventricular Assist Devices
Total Artificial Heart
CardioWestTM Total Artificial Heart
AbioCor® (Abiomed)
Third-Generation Left Ventricular Assist Device—HeartWare® Ventricular Assist Device
SUMMARY
CHAPTER 8:
Percutaneous Mechanical Support
INTRODUCTION
INDICATIONS FOR MECHANICAL ASSIST DEVICES
Bridge to Recovery
Bridge to Transplant
Destination Therapy
DEVICES USED FOR SHORT-TERM MECHANICAL CIRCULATORY SUPPORT
Percutaneous Devices
Intra-Aortic Balloon Pump
TandemHeart®
Impella 2.5
Extracorporeal Membrane Oxygenation
Centrifugal Ventricular Assist Device
Pulsatile Assist Devices for Short-term Use
Right Ventricular Assist Devices and Biventricular Assist Devices
CHAPTER 9:
Cardiac Resynchronization Therapy
INTRODUCTION
RATIONALE FOR CARDIAC RESYNCHRONIZATION THERAPY
REVIEW OF MAJOR CARDIAC RESYNCHRONIZATION THERAPY TRIALS
EFFECTS OF CARDIAC RESYNCHRONIZATION THERAPY
EMERGING INDICATIONS AND EXPANDING ROLES OF CARDIAC RESYNCHRONIZATION THERAPY
Patients with Mild Heart Failure
Patients with Atrial Fibrillation
Patients with Heart Failure and Narrow QRS Complex
Patients with Heart Failure and Intermediate QRS Complex Duration
Heart Failure Patients with Standard Pacing Indication for Bradycardia
CARDIAC RESYNCHRONIZATION THERAPY NONRESPONDERS AND METHODS TO IMPROVE RESPONSE
COMPLICATIONS OF CARDIAC RESYNCHRONIZATION THERAPY
FUTURE DIRECTIONS
ACCF/AHA/HRS Guidelines: What is new?
CHAPTER 10:
Sudden Cardiac Death and Implantable Cardioverter-Defibrillator
INTRODUCTION
IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR TRIALS AND GUIDELINES IN SECONDARY SUDDEN CARDIAC DEATH PREVENTION
IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR TRIALS AND GUIDELINES IN PRIMARY SUDDEN CARDIAC DEATH PREVENTION
Implantable Cardioverter-Defibrillators in Coronary Artery Disease Cardiomyopathy
Implantable Cardioverter-Defibrillators in Nonischemic Cardiomyopathy
Implantable Cardioverter-Defibrillators in Heart Failure of Any Etiology
Implantable Cardioverter-Defibrillators in New Onset (within 30 days of Myocardial Infarction) Ischemic Cardiomyopathy
REFINING IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS SELECTION CRITERIA
Critical Appraisal of Left Ventricular Ejection Fraction-Based Patient Selection
Value of Noninvasive and Invasive Risk Stratification
SPECIAL POPULATIONS WITH LIMITED OR NONESTABLISHED IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR BENEFIT
Ischemic Cardiomyopathy versus Nonischemic Cardiomyopathy
Men versus Women, Race and Ethnicity
Implantable Cardioverter-Defibrillator in Patients with Severe Renal Disease
Implantable Cardioverter-Defibrillator Paradox in Patients Early After Myocardial Infarction
DISPARITY IN ICD USE AND NONEVIDENCE-BASED ICD IMPLANTATIONS
COMPLICATIONS OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR
Procedural Complications
Lead or Pulse Generator-Related Complications
Inappropriate Shocks
Right Ventricular Pacing and Heart Failure
PSYCHOSOCIAL AND ETHICAL ISSUES IN IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR
EMERGING TECHNOLOGY AND FUTURE DIRECTIONS
CHAPTER 11:
Atrial Arrhythmias in Heart Failure
INTRODUCTION
EPIDEMIOLOGY
PATHOPHYSIOLOGY
TREATMENT
Anticoagulation
Rate Control
Rhythm Control
Rate versus Rhythm Control
Ablation of the Atrioventricular Node and Permanent Pacing
Pulmonary Vein Isolation
CONCLUSION
CHAPTER 12:
Ventricular Tachyarrhythmias in Patients with Congestive Heart Failure
INTRODUCTION
INITIAL EVALUATION
ACUTE THERAPY
Polymorphic Ventricular Tachycardia
Monomorphic Ventricular Tachycardia
Ventricular Tachycardia Storm
Ventricular Tachycardia/Ventricular Fibrillation in Patients with Left Ventricular Assist Devices
LONG-TERM THERAPY
Implantable Cardioverter Defibrillator
Antiarrhythmic Drug
Amiodarone
Dofetilide
Beta-blockers
Non-Antiarrhythmic Drugs
VENTRICULAR TACHYCARDIA ABLATION
FUTURE DIRECTIONS
ACKNOWLEDGMENTS
DISCLOSURES
CHAPTER 13:
Heart Transplantation
INTRODUCTION
INDICATIONS
PATIENT SELECTION
CONTRAINDICATIONS
Age
Body Mass Index
Pulmonary Disease
Diabetes Mellitus
Renal Disease
Hepatic Disease
Non-Cardiac Vascular Disease
Infectious Disease
Malignancy
Substance Abuse
Psychosocial
LISTING AND WAITING FOR TRANSPLANT
DONOR SELECTION
DONOR CARDIAC EVALUATION
DONOR EXTRA-CARDIAC EVALUATION
Donor Age
Donor Size
Ischemic Time
DONOR HEART IMPLANTATION
POSTOPERATIVE MANAGEMENT OF THE HEART TRANSPLANT RECIPIENT
Induction Therapy
IMMUNOSUPPRESSION AND REJECTION
Hyperacute Rejection
Acute Allograft Rejection
Acute Antibody Mediated Rejection
Acute Cellular Rejection
Treatment of Acute Cellular Rejection
Maintenance Immunosuppression
Corticosteroids
Calcineurin Inhibitors
Antiproliferatives
Target of Rapamycin Inhibitors
Long-Term Outcomes
COMPLICATIONS
Infection
Malignancy
Hypertension
Diabetes
Post-Transplant Vasculopathy
CONCLUSION
CHAPTER 14:
Heart Failure
INTRODUCTION
HEART FAILURE CENTERS
HEART FAILURE EDUCATION
SYMPTOM RECOGNITION AND EDUCATION
DIETARY EDUCATION
EXERCISE AND ACTIVITY EDUCATION
MEDICATION EDUCATION
RESOURCES FOR PATIENT EDUCATION
DISCHARGE PLANNING AND READMISSIONS
CONCLUSION
INDEX
TOC
Index
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