Editors Alan S Maisel MD
Professor of Medicine Director, CCU and HF Program Department of Medicine and Cardiology VA Medical Center, University of California San Diego, California, USA
Gerasimos S Filippatos Md Fesc
Heart Failure Unit, Department of Cardiology Attikon University Hospital, University of Athens School of Medicine, Athens, Greece
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Heart Failure The Expert's Approach / Eds. Alan S Maisel and Gerasimos S Filippatos
First Edition: 2014
9789350909492
Printed at
5Dedicated to
Fran, Amanda, Naomi, Max, Samantha, and Sofie and
My students and fellows
Alan S Maisel
Maria and Angela and
My students and fellows
Gerasimos S Filippatos
7Contributors
Editors
- Alan S Maisel md
- Professor of Medicine
- Director, CCU and HF Program
- Department of Medicine and Cardiology
- VA Medical Center, University of California
- San Diego, California, USA
- Gerasimos S Filippatos md fesc
- Heart Failure Unit, Department of Cardiology
- Attikon University Hospital
- University of Athens
- School of Medicine, Athens, Greece
Contributing Authors
- Eric Adler md
- Associate Professor of Medicine and Medical Director of Cardiac Transplant
- Department of Medicine, Division of Cardiology
- University of California
- San Diego, California, USA
- Ali Ahmed md mph
- Professor of Medicine and Epidemiology
- University of Alabama at Birmingham
- Birmingham, Alabama, USA
- Nancy M Albert phd ccns chfn ccrn ne-bc faha fccm
- Associate Chief Nursing Officer
- Research and Innovation, Nursing Institute
- Cleveland Clinic Health System and Clinical Nurse Specialist
- Heart and Vascular Institute, Cleveland Clinic
- Cleveland, Ohio, USA
- Khwaja S Alim md
- Practicing Internal Medicine
- St. Martin Dominican Hospital
- Las Vegas, Nevada, USA
- Lora AlKhawam md
- Department of Emergency Medicine
- Northwestern University Feinberg School of Medicine
- Chicago, Illinois, USA
- Inder S Anand md frcp d phil
- Professor of Medicine
- University of Minnesota Medical School
- Director, Heart Failure Program, VA Medical Center
- Minneapolis, Minnesota, USA
- Hermineh Aramin md
- Research Assistant
- VA Health Care Center
- San Diego, California, USA
- Eloisa Arbustini md
- Director of the Transplant Research Area
- Director of the Centre for Inherited Cardiovascular Diseases
- Director of the Molecular Genetic Laboratory
- Fondazione IRCCS Policlinico San Matteo
- Pavia, Italy
- Ajay Bahl md dnb mrcp dm
- Associate Professor
- Department of Cardiology
- Postgraduate Institute of Medical Education and Research
- Chandigarh, India
- Manish Bansal md dnb fase fiscu
- Senior Consultant Cardiology
- Department of Cardiology
- Medanta - The Medicity
- Gurgaon, Haryana, India
- Denise D Barnard md facc
- Clinical Professor of Medicine
- Advanced Heart Failure, Cardiac Transplantation and Mechanical Assist Device Program
- UCSD Health Sciences and UCSD School of Medicine
- San Diego, California, USA
- Tyler W Barrett md msci facep
- Associate Professor
- Department of Emergency Medicine
- Vanderbilt University Medical Center
- Nashville, Tennessee, USA
- Tina Baykaner md
- Cardiology Fellow
- Department of Cardiology
- University of California
- San Diego, California, USA
- Vassiliki Bistola md phd
- Heart Failure Unit, Attikon University Hospital
- University of Athens
- Athens, Greece
- Daniel G Blanchard md facc
- Professor of Clinical Medicine
- Director, UCSD Cardiology Fellowship Program
- UCSD Sulpizio Cardiovascular Center
- San Diego, California, USA
- Rudolf A de Boer md phd fesc
- Department of Cardiology
- University Medical Center Groningen
- University of Groningen
- Groningen, The Netherlands
- Harleah G Buck phd rn chpn fpn
- Assistant Professor
- College of Nursing
- The Pennsylvania State University
- State College, Pennsylvania, USA
- Javed Butler md mph
- Professor of Medicine
- Emory Cardiovascular Clinical Research Institute
- Atlanta, Georgia, USA
- Jeffrey Chan md
- Physician
- University of California, San Diego Medical Center
- San Diego, California, USA
- Jia Hoong Chi bpharm
- Pharmacist
- Lorong Bersatu, Off Jalan Damai
- Luyang, Sabah, Malaysia
- Anthony Choi md
- Department of Cardiology
- Naval Medical Center San Diego
- San Diego, California, USA
- Rajiv Choudhary mph md
- Internal Medicine Resident
- Department of Internal Medicine
- Capital Health Regional Medical Center – Fuld
- Trenton, New Jersey, USA
- John GF Cleland md phd frcp fesc facc
- Professor of Clinical Cardiology
- National Heart and Lung Institute
- Royal Brompton and Harefield Hospitals, Imperial College
- London, England, UK
- Robert T Cole md
- Assistant Professor of Medicine
- Emory Cardiovascular Clinical Research Institute
- Atlanta, Georgia, USA
- Maria R Costanzo md facc faha
- Medical Director
- Midwest Heart Specialists-Advocate Medical Group
- Heart Failure and Pulmonary Arterial Hypertension Programs
- Medical Director
- Edward Hospital Center for Advanced Heart Failure
- Naperville, Illinois, USA
- Justin Cox md
- Cardiology Fellow
- Naval Medical Center San Diego
- San Diego, California, USA
- Assistant Professor of Medicine
- Uniformed Services University of the Health Sciences
- Bethesda, Maryland, USA
- Lori B Daniels md mas
- Director
- Coronary Care Unit
- Associate Professor of Medicine
- Division of Cardiology
- University of California
- Sulpizio Cardiovascular Center
- San Diego, California, USA
- Eugene C DePasquale md
- Ahmanson-UCLA Cardiomyopathy Center
- David Geffen School of Medicine
- Los Angeles, California, USA
- Benjamin Dicken mbbs mrcp
- Department of Cardiology
- Hull York Medical School
- Castle Hill Hospital, University of Hull
- Kingston-upon-Hull, England, UK
- Riet Dierckx md
- Clinical Lecturer Telehealth
- Academic Department of Cardiology
- Hull York Medical School
- Kingston upon Hull, England, UK
- Mary A Dolansky phd rn
- Associate Professor
- Case Western Reserve University
- Frances Payne Bolton School of Nursing
- Cleveland, Ohio, USA
- Christos Dresios md
- Centre for Cardiovascular Sciences
- City Hospital, University of Birmingham
- Birmingham, England, UK
- Lothar Faber md fesc faha
- Cardiologist, Expert for HCM, Cardiac Imaging
- Heart and Diabetes Center NRW
- Bad Oeynhausen, North Rhine-Westphalia, Germany
- Gregg C Fonarow md facc faha
- Eliot Corday Professor of Cardiovascular Medicine and Science
- Director, Ahmanson-UCLA Cardiomyopathy Center; Co-Chief of Clinical Cardiology, UCLA Division of Cardiology Co-Director, UCLA Preventative Cardiology Program
- Los Angeles, California, USA
- Nancy J Gardetto phd fnp-bc
- Clinical Nurse Practitioner
- Nurse Researcher, Heart Failure and Cardiac Transplantation Program
- VA San Diego Healthcare System
- San Diego, California, USA
- Luna Gargani md
- Cardiologist
- Researcher, Institute of Clinical Physiology
- National Research Council
- Chair of the TTE Sub-Committee
- European Association of Cardiovascular Imaging
- Pisa, Italy
- Maurizia Grasso phd
- Centre for Inherited Cardiovascular Diseases
- Fondazione IRCCS Policlinico San Matteo
- Pavia, Italy
- Barry Greenberg md
- Professor of Medicine
- University of California, San Diego
- Director, Advanced Heart Failure Treatment Program for the UCSD Health System
- San Diego, California, USA
- Erik A Green ba
- VA Hospital
- San Diego, California, USA
- Hardeep K Grewal pgdcc fcnic
- Attending Consultant Cardiology
- Department of Cardiology
- Medanta - The Medicity
- Gurgaon, Haryana, India
- Meghana G Halkar md
- Clinical Associate Staff
- Cleveland Clinic
- Cleveland, Ohio, USA
- J Thomas Heywood md
- Director, Heart Failure Research and Recovery
- Director, Left Ventricular Assist Device Program
- Scripps Clinic
- San Diego, California, USA
- Erin Higginbotham bs
- Medical Student
- Keck School of Medicine
- University of Southern California
- Los Angeles, California, USA
- Scott Hopkins md
- Cardiology Fellow
- Naval Medical Center San Diego
- San Diego, California, USA
- Connie Huberty ms rn apn-bc chfn
- Heart Failure Nurse Practitioner
- Edward Hospital
- Naperville, Illinois, USA
- Fatima Iqbal md
- Research Associate
- VA San Diego Healthcare System
- San Diego, California, USA
- Navaid Iqbal md
- Research Coordinator
- VA San Diego Healthcare System
- San Diego, California, USA
- Affan Irfan md
- Resident
- Internal Medicine Program
- University of Illinois – Urbana Champaign
- Champaign, Illinois, USA
- Shiro Ishihara md
- Inserm U942
- Nippon Medical School Musashi-Kosugi Hospital
- Paris, France
- Tiny Jaarsma phd rn
- Professor
- Department of Social and Welfare Studies
- Linköping University
- Linköping, Sweden
- Allan S Jaffe md
- Professor of Medicine
- Professor of Laboratory Medicine and Pathology
- Mayo Clinic
- Rochester, Minnesota, USA
- Ewa A Jankowska md phd fesc
- Department of Heart Diseases
- Wroclaw Medical University
- Cardiology Department, Military Hospital
- Wroclaw, Poland
- James L Januzzi Jr md facc fesc
- Director
- Cardiac Intensive Care Unit
- Massachusetts General Hospital
- Boston, Massachusetts, USA
- Brian E Jaski md
- San Diego Cardiac Center
- Medical Director
- Advanced Heart Failure/Cardiac Transplant
- Sharp Memorial Hospital
- San Diego, California, USA
- Robert L Jesse md phd
- Principal Deputy Under Secretary for Health
- Veterans Health Administration
- Richmond, Virginia, USA
- Mariell Jessup md
- Advanced Heart Failure and Transplant Cardiologists
- Division of Cardiovascular Medicine
- Department of Medicine
- University of Pennsylvania School of Medicine
- Philadelphia, Pennsylvania, USA
- Corrine Y Jurgens phd rn anp-bc faha
- Associate Professor, Director of Cardiovascular Research
- School of Nursing, Stony Brook University
- Stony Brook, New York, USA
- Ravi R Kasliwal md dm fimsa mnams
- Chairman
- Clinical and Preventive Cardiology Community Outreach and Education Program
- Medanta Heart Institute
- Medanta - The Medicity
- Gurgaon, Haryana, India
- Matt M Kawahara ba
- Staff Research Associate
- VA San Diego Healthcare System
- San Diego, California, USA
- Basem Khishfe md
- Department of Emergency Medicine
- Cook County Hospital
- Chicago, Illinois, USA
- Fatima Khusro md
- Research Associate
- VA San Diego Healtcare System
- San Diego, California, USA
- Benjamin A Kipper bs
- VA Medical Center La Jolla
- San Diego, California, USA
- Oakland University William Beaumont School of Medicine
- Rochester, Michigan, USA
- Takahide Kodama md phd
- Cardiovascular Center
- Toranomon Hospital
- Toranomon, Tokyo, Japan
- David E Krummen md
- Associate Professor of Medicine
- University of California, San Diego and VA San Diego Healthcare System
- San Diego, California, USA
- Vijaya A Kumar md faafp
- Assistant Professor
- Department of Emergency Medicine
- Wayne State University School of Medicine
- Detroit, Michigan, USA
- Dick Kuo md facep
- Baylor College of Medicine
- Houston, Texas, USA
- Rashid Kysia md mph
- Department of Emergency Medicine
- Cook County Hospital
- Chicago, Illinois, USA
- Jennifer LaCorte rn msn ccrn
- Technical Clinical Trainer
- Baxter-Gambro Renal, Aquapheresis Systems
- Naperville, Illinois, USA
- Gautam G Lalani md
- Fellow, Cardiac Electrophysiology
- University of California
- San Diego, California, USA
- Carolyn SP Lam mbbs mrcp ms
- Associate Professor, Department of Internal Medicine National University of Singapore
- Consultant, Cardiac Department National University Hospital, Singapore
- Director, Women's Heart Health Clinic, National University Heart Centre, Singapore
- Elizabeth Lee bs
- Research Coordinator
- Maisel Cardiology Research Lab
- Saratoga, California, USA
- Phillip D Levy md mph
- Associate Professor of Emergency Medicine
- Assistant Director of Clinical Research
- Cardiovascular Research Institute
- Associate Director of Clinical Research
- Department of Emergency Medicine
- Wayne State University School of Medicine
- Detroit, Michigan, USA
- Siow-Yen Liau mpharm phd
- Pharmacist, Pharmacy Department
- Queen Elizabeth Hospital II, Ministry of Health
- Kota Kinabalu, Sabah, Malaysia
- Houng-Bang Liew mb bch bao frcp fnham
- Head, Department of Cardiology
- Queen Elizabeth Hospital II, Ministry of Health
- Kota Kinabalu, Sabah, Malaysia
- Gregory YH Lip md frcp fesc facc
- Centre for Cardiovascular Sciences
- City Hospital, University of Birmingham
- Birmingham, England, United Kingdom
- Alexander R Lyon ma bm bch mrcp phd
- Senior Lecturer and Consultant Cardiologist
- Royal Brompton Hospital
- London, England, UK
- Josep Masip md phd fesc
- ICU Director
- Hospital Sant Joan Despí Moisès Broggi
- Consorci Sanitari Integral
- Associate Professor of Cardiology
- University of Barcelona
- Barcelona, Spain
- Patrick McCann md
- Fellow in Cardiac Failure
- Department of Medicine, Division of Cardiology
- University of California
- San Diego, California, USA
- Alexandre Mebazaa md phd
- Department of Anesthesia and Critical Care
- U942 Inserm, Lariboisière-Saint-Louis Hospital
- University Paris Diderot
- Paris, France
- Hirsch S Mehta md
- Physician, Stanford University School of Medicine
- Stanford, California, USA
- Wouter C Meijers md
- Department of Cardiology
- University Medical Center Groningen
- University of Groningen
- Groningen, The Netherlands
- Wayne L Miller md phd
- Mayo Clinic
- Rochester, Minnesota, USA
- Rajeev C Mohan md
- Division of Cardiology
- Scripps Clinic
- San Diego, California, USA
- Andrew C Morley-Smith ma mb bchir mrcp
- Clinical Research Fellow
- Imperial College London and Royal Brompton and Harefield NHS Foundation Trust
- London, England, UK
- Nupoor Narula md
- Centre for Inherited Cardiovascular Diseases
- Fondazione IRCCS Policlinico San Matteo
- Pavia, Italy
- Department of Medicine, Mayo Clinic
- Rochester, Minnesota, USA
- Silvia Navarin md
- Emergency Medicine Postgraduate School Resident
- Department Medical-Surgery Sciences and Translational Medicine
- Post Graduate School of Emergency Medicine
- Sapienza University, Sant'Andrea Hospital
- Rome, Italy
- Keshav R Nayak md facc fscai
- Director, Cardiac Catheterization Laboratory
- Naval Medical Center San Diego
- San Diego, California, USA
- Michel Noutsias md fesc
- Department of Cardiology – Internal Medicine
- University Hospital of Jena
- Jena, Thuringia, Germany
- Peter S Pang md msci facep faaem facc faha
- Associate Chief, Associate Professor
- Department of Emergency Medicine and Medicine
- Northwestern University Feinberg School of Medicine
- Chicago, Illinois, USA
- John T Parissis md
- Associate Professor of Cardiology
- Heart Failure Clinic
- Attikon University Hospital, University of Athens
- Athens, Greece
- Sunaina Parsons mbchb mrcp
- Clinical Research Fellow
- Centre for Cardiovascular and Metabolic Research
- Hull York Medical School
- Kingston-upon-Hull, England, UK
- Kanan Patel mbbs mph
- Academic Specialist
- University of California
- San Francisco, California, USA
- Minal V Patel bsc
- Research Coordinator
- Department of Medicine, Cardiology
- University of California, San Diego
- VA San Diego Healthcare System
- San Diego, California, USA
- W Frank Peacock md facep
- Professor, Emergency Medicine
- Associate Chair and Research Director
- Baylor College of Medicine
- Houston, Texas, USA
- Pierpaolo Pellicori md fesc
- Clinical Research Fellow
- Department of Academic Cardiology
- Castle Hill Hospital
- Kingston upon Hull, England, UK
- Bertram Pitt md
- School of Medicine, University of Michigan
- Ann Arbor, Michigan, USA
- Piotr Ponikowski md phd fesc
- Department of Heart Diseases
- Wroclaw Medical University
- Cardiology Department, Military Hospital
- Wroclaw, Poland
- Christian Prinz md fesc
- Cardiologist, Expert for HCM, Cardiac Imaging, Cardiac Biomarkers
- Heart and Diabetes Center NRW
- Bad Oeynhausen, North Rhine-Westphalia, Germany
- Sonal Sarkariya md
- Internal Medicine Resident Physician
- University of California
- San Diego, California, USA
- Michelle Schlueter pharm d
- Department of Cardiology
- University of California, San Diego School of Medicine
- San Diego, California, USA
- Amir A Schricker md ms
- Cardiac electrophysiology fellow
- University of California, San Diego Medical Center
- VA San Diego Healthcare System
- San Diego, California, USA
- Alessandra Serio md phd
- Cardiologist
- Centre for Inherited Cardiovascular Diseases
- Fondazione IRCCS Policlinico San Matteo
- Pavia, Italy
- Abhishek S Shah md
- University of California
- San Diego, California, USA
- Kevin S Shah md
- Resident Physician
- Department of Internal Medicine
- University of California
- San Diego, California, USA
- Ahmad Shoaib mbbs mrcp
- Honorary Senior Clinical Tutor, Hull York Medical School
- Clinical Research Fellow
- Department of Cardiology
- Division of Cardiovascular and Respiratory Studies
- Post Graduate Medical Institute
- Castle Hill Hospital
- Kingston-upon-Hull, England, UK
- Salvatore Di Somma md phd
- Professor of Medicine
- Director Emergency Medicine
- Chairman Postgraduate School of Emergency Medicine
- Department of Medical-Surgery Sciences and Translational Medicine
- Sapienza University, Sant'Andrea Hospital
- Rome, Italy
- Anna Strömberg phd rn
- Professor, Division of Nursing
- Department of Medical and Health Sciences
- Linköping University
- Linköping, Sweden
- José Tallaj md
- University of Alabama at Birmingham
- Veterans Affairs Medical Center
- Birmingham, Alabama, USA
- WH Wilson Tang md
- Professor of Medicine
- Cleveland Clinic
- Cleveland, Ohio, USA
- Allart R van der Velde md
- Department of Cardiology
- University Medical Center Groningen
- University of Groningen
- Groningen, The Netherlands
- Joyce W Wald do
- Advanced Heart Failure and Transplant Cardiologists
- Division of Cardiovascular Medicine
- Department of Medicine
- University of Pennsylvania School of Medicine
- Philadelphia, Pennsylvania, USA
- Brian S Wasserman md
- Department of Emergency Medicine
- Vanderbilt University Medical Center
- Nashville, Tennessee, USA
- Sandra Williams md do mph
- Baylor College of Medicine
- Houston, Texas, USA
- Joel R Wilson md
- Assistant Professor of Medicine
- Department of Internal Medicine
- Division of Cardiology and Department of Radiology
- University of California
- San Diego, California, USA
- Raymond CC Wong mbbs mrcp
- Senior Consultant
- National University Heart Centre
- Singapore
- Yu Xie md
- Chief Medical Resident of the Internal Medicine Program
- University of California
- San Diego, California, USA
- Yang Xue md
- Medical Center for Cardiovascular Medicine
- University of California
- San Diego, California, USA
- Jian Zhang md phd
- Professor
- Heart Failure Center
- Fuwai Cardiovascular Hospital
- National Center for Cardiovascular Diseases
- Chinese Academy of Medical Sciences and Peking Union Medical College
- Beijing, China
- Yuhui Zhang md
- Associate Professor
- Heart Failure Center
- Fuwai Cardiovascular Hospital
- National Center for Cardiovascular Disease
- Chinese Academy of Medical Sciences and Peking Union Medical College
- Beijing, China
It is clear to every healthcare practitioner that heart failure has become a worldwide epidemic. The scourge of obesity and heart disease and the ageing of the population have certainly contributed to this phenomenon as has the longer survival following therapeutic interventions for acute myocardial infarction and cardiac disease in general. Thus, with the increasing prevalence of heart failure, it is important to examine the newest data as well, as the latest treatment paradigms.
It was our idea to make this a hands-on book; that is, something you could not only sit down for a leisurely read, but could open up to succinct chapters as the occasion arose, and come right to important information on the workup and treatment of all aspects of heart failure. To this end, we had instructed our expert contributors to punctuate their chapters with new and improved algorithms that one could immediately use at the bedside or the office. “How to really do it right” was the mantra used. We also had the idea to write small chapters with brief text, many figures and treatment algorithms, and a small number of selected references. This was easy to do in some chapters like conventional drug therapy. In more controversial areas with lower level of evidence, we thought that the reader would benefit from more extensive information and suggested literature to read.
Professor Peter Pang from Northwestern University handled on the Emergency Department. In this section, we have covered the spectrum of what one would see and do in the emergency. From the early evaluation of the dyspneic patient, to the diagnostic techniques, including biomarkers, echocardiography and impedance, to appropriate triage, risk stratification, and treatment of the patient, we offer practical suggestions to simplify diagnosis and management in this urgent care setting.
deals with Heart Failure in the Hospital, which includes the use of biomarkers, the latest medical treatments, and the associated comorbidities, such as hyponatremia, coronary artery disease, and cardiorenal syndromes.
deals with how to take care of Chronic Heart Failure Patients in the Outpatient Setting. There are chapters on monitoring with echocardiography and biomarkers, as well as strategic chapters on preserved ejection fraction, atrial fibrillation, and issues with anticoagulation.
deals with Special Issues in Heart Failure. This includes, age, gender, sex and ethnic issues, along with heart failure in other countries as well as the Veterans Systems. We also deal with heart failure in the Nursing home setting and get a good nursing perspective.
deals with the approach to End-stage Heart Failure, and the final section deals with practical recommendations for diagnosis and management of cardiomyopathies.
We hope the readers, whether they be primary care physicians, house officers, practicing cardiologists, or nurses, will both learn and enjoy the contents of this book.
Alan S Maisel
Gerasimos S Filippatos
17Acknowledgments
I would like to first acknowledge the now deceased Dr Ralph Shabetai, who as my first chief of cardiology gave me his time and advice and turned my interests towards challenges of the heart failure patient. Never have I met a more selfless and giving man than Ralph. Second, I would like to thank my laboratory personnel without whose help and support I would never have been productive. A special thanks to my lab director, Steve Carter, for 25 years of unwavering loyalty. I would like to thank the Publishers M/s Jaypee Brothers Medical Publishers for being incredibly supportive to this long endeavor, in particular, Dr Neeraj Choudhary for his friendship and advice. Finally, I would be completely remiss if I did not thank my five children, who last summer lost their mother and on a daily basis remind me of why God put me on Earth. And Fran, my lovely wife, thanks for putting up with my long hours, extensive travel, and crazy sense of humor.
Alan S Maisel
19Acknowledgments
I would like to acknowledge Professor George Baltopoulos, who trained me in critical care and helped me, from my first steps in research to my doctoral degree, more than 25 years ago. I also owe much to Professor Lambros Anthopoulos, former Chair of the Department of Cardiology at Evangelismos Hospital, who gave me the opportunity to develop and direct the Heart Failure Unit and the Intensive Cardiac Care Unit at Evangelismos Hospital in the mid-1990s; and to Professor Dimitrios Kremastinos, founder of the Attikon University Hospital, who asked me 10 years ago to organize and run the Heart Failure Unit of the Department. However, my biggest supporters are my wife Maria and my daughter Angela. It is difficult to make space for a life away from work. This becomes impossible if you are trying to find time to write a book on the top of the other activities. Thank you for your support.
Gerasimos S Filippatos