Algorithms in Heart Failure Alan S Maisel, Gerasimos S Filippatos
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FM1Algorithms in Heart FailureFM2
FM3Algorithms in Heart Failure
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 FHFA Professor of Cardiology Heart Failure Unit, Department of Cardiology Attikon University Hospital University of Athens, School of Medicine Athens, Greece
FM4
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Algorithms in Heart Failure
First Edition: Digital Version 2017
9789385999642
FM5Contributors
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 FHFA
    Professor of Cardiology
    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
    Driector of Advanced Heart Failure and Cardiac Transplantation
    Department of Medicine
    University of California
    San Diego, California, USA
  • Nancy M Albert PhD CCNS CHFN CCRN NE-BC FAHA FCCM FAAN
    Associate Chief Nursing Officer
    Nursing Research and Innovation
    Clinical Nurse Specialist
    Kaufman Center for Heart
    Failure, Heart and Vascular
    Institute, Cleveland Clinic
    Cleveland, Ohio, USA
  • Khwaja S Alim MD
    Practicing Internal Medicine
    St. Martin Dominican Hospital
    Las Vegas, Nevada, USA
  • Hermineh Aramin
    Medical Doctor
    VA Medical Center
    Department of Cardiology
    San Diego, California, USA
  • Boris Arbit MD
    Cardiology Fellow
    Department of Medicine
    University of California
    San Diego, California, USAFM6
  • Kimberly C Atianzar MD
    Fellow, Advanced Cardiovascular
    Imaging
    Department of Internal Medicine
    University of California
    San Diego, California, USA
  • Vasiliki Bistola MD
    Consultant Cardiologist
    Department of Cardiology
    Attikon University Hospital
    Athens, Greece
  • Daniel G Blanchard MD FACC FAHA FASE
    Professor of Medicine
    Department of Cardiovascular
    Medicine
    UC San Diego Cardiovascular
    Center
    San Diego, California, USA
  • Rudolf A de Boer MD PhD FESC FHFA
    Professor of Translational
    Cardiology
    Department of Cardiology
    University Medical Center
    Groningen
    Groningen, Netherlands
  • Jeffrey Chan MD
    Resident Physician
    Department of Anesthesiology
    University of Washington
    Seattle, Washington, USA
  • Anthony J Choi ABIM
    Cardiologist
    Department of Cardiology
    Naval Medical Center
    San Diego, California, USA
  • Lori B Daniels MD MAS FACC
    Professor of Medicine
    Director, Coronary Care Unit
    University of California
    San Diego, California, USA
  • Jason M Duran MD PhD
    Resident Physician
    Department of Medicine
    University of California
    San Diego, California, USA
  • Jeremy Egnatios
    Medical Student
    Department of Medicine
    University of California
    San Diego, California, USA
  • Lothar Faber MD FESC FAHA FACC
    Professor Department for Cardiology
    Heart and Diabetes Center NRW
    Bad Oeynhausen, North Rhine-
    Westphalia, Germany
  • Luna Gargani MD PhD
    Cardiologist and Researcher
    Institute of Clinical Physiology
    National Research Council
    Pisa, Italy
  • Erik A Green
    Medical Student
    Tulane University School of Medicine
    New Orleans, Louisiana, USA
  • Meghana G Halkar MD FACP
    Cardiology Hospitalist
    Department of Cardiovascular Medicine
    MedStar/Cleveland Clinic Heart and Vascular Institute
    Washington, DC, USAFM7
  • JT Heywood MD
    Director, Advanced Heart Failure,
    Mechanical Circulatory Support Program
    Department of Cardiology
    Scripps Clinic
    San Diego, California, USA
  • Affan B Irfan MD PhD
    Clinical Cardiology Fellow
    Department of General Cardiology and Department of Physiology
    University of Louisville
    Louisville, Kentucky, USA
  • Shiro Ishihara MD
    Research Associate
    Department of Cardiology
    Nippon Medical School Musashi-
    Kosugi Hospitals
    Kanagawa, Japan
    Biomarkers and Heart Diseases,
    UMR-942, Institut National de la
    Santé et de la Recherche Médicale (INSERM)
    Paris, France
  • Tiny Jaarsma PhD RN
    Professor in Nursing
    Department of Social and Welfare Studies
    Linköping University
    Linköping, Sweden
  • Allan S Jaffe FAHA FACC FESC
    Professor
    Department of Cardiology and Laboratory Medicine and Pathology
    Mayo Clinic and Medical School
    Rochester, Minnesota, USA
  • Brian E Jaski MD
    Medical Director, Advanced Heart
    Failure and Cardiac Transplant
    Program
    Sharp Memorial Hospital
    Director of Clinical Research
    San Diego Cardiac Center
    San Diego, California, USA
  • Corrine Y Jurgens PhD RN ANP FAHA FAAN
    Associate Professor and Director
    of Cardiovascular Research
    School of Nursing, Stony Brook
    University
    Stony Brook, New York, USA
  • Matt M Kawahara BA
    Staff Research Associate
    VA San Diego Healthcare System
    San Diego, California, USA
  • Benjamin A Kipper BS MD
    Medical Student
    School of Medicine
    Oakland University William
    Beaumont School of Medicine
    Rochester, Michigan, USA
  • David E Krummen MD FACC FHRS
    Associate Professor
    Department of Medicine
    University of California
    Director of Electrophysiology
    VA San Diego Healthcare System
    San Diego, California, USA
  • Vijaya A Kumar MD MPH
    Assistant Professor
    Department of Emergency
    Medicine, Wayne State University
    Detroit, Michigan, USAFM8
  • Gautam G Lalani MD
    Physician
    Department of Cardiology and Cardiac Electrophysiology
    Kaiser Permanente San Diego
    San Diego, California, USA
  • 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
    Director, Clinical Research Center
    Wayne State University School of
    Medicine
    Detroit, Michigan, USA
  • Alexander R Lyon MA BM BCh PhD FRCP
    BHF Senior Lecturer and Honorary
    Consultant Cardiologist
    NIHR Cardiovascular Biomedical
    Research Unit
    Royal Brompton and Harefield
    NHS Foundation Trust and
    National Heart and Lung Institute,
    Imperial College London
    London, England, UK
  • Nicholas A Marston MD
    Chief Medical Resident
    Department of Internal Medicine
    University of California
    San Diego, California, USA
  • Josep Masip MD PhD FESC
    Director
    Department of Intensive Care
    Department Consorci Sanitari Integral
    Head
    Department of Cardiology
    Hospital Sanitas CIMA
    Associate Professor
    Department of Cardiology
    University of Barcelona
    Barcelona, Spain
  • Patrick McCann MD
    Director of Heart Failure and Mechanical Circulatory Support
    Department of Cardiology
    Palmetto Health
    Columbia, South Carolina, USA
  • Alexandre Mebazaa MD PhD
    Professor
    Department of Anesthesiology
    and Critical Care Medicine
    Biomarkers and Heart Diseases,
    UMR-942, Institut National de la
    Santé et de la Recherche Médicale (INSERM)
    Department of Anesthesiology
    and Intensive Care
    Lariboisière-Saint-Louis University Hospital
    Assistance Publique–Hôpitaux de Paris, Université Paris
    Diderot, Paris, France
  • Hirsch S Mehta MD FACC
    Associate Director
    San Diego Cardiac Center and
    Sharp Memorial Hospital
    San Diego, California, USAFM9
  • Wouter C Meijers MD
    Professor
    Department of Cardiology
    University Medical Center
    Groningen
    University of Groningen
    Groningen, Netherlands
  • Wayne Miller FAHA FACC
    Professor
    Department of Cardiology
    Mayo Clinic and Medical School
    Rochester, Minnesota, USA
  • Rajeev C Mohan MD
    Advanced Heart Failure and
    Transplant Cardiology Fellow
    Department of Cardiology
    Cedars-Sinai Medical Center
    Los Angeles, California, USA
  • Andrew C Morley-Smith MB BChir MRCP
    BHF Clinical Research Fellow
    NIHR Cardiovascular Biomedical
    Research Unit, Royal Brompton and Harefield NHS
    Foundation Trust and National
    Heart and Lung Institute, Imperial
    College London
    London, England, UK
  • Silvia Navarin MD
    Resident in Emergency Medicine
    Department of Emergency
    Medicine, Sapienza University Sant'Andrea Hospital
    Rome, Italy
  • Keshav R Nayak MD FACC FSCAI
    Director, Cardiac Cathlabs
    Department of Cardiology
    Naval Medical Center San Diego
    San Diego, California, USA
  • Michel Noutsias FESC
    Assistant Medical Director
    Department of Cardiology
    University Hospital of Jena
    Jena, Thuringia, Germany
  • Minal V Patel BSc
    Research Coordinator
    Department of Medicine, Cardiology
    University of California at San Diego
    VA San Diego Healthcare System
    San Diego, California, USA
  • John Parissis MD
    Associate Professor of Cardiology
    Department of Cardiology
    Attikon University Hospital
    Athens, Greece
  • W Frank Peacock MD FACEP
    Professor
    Department of Emergency Medicine
    Baylor College of Medicine
    Houston, Texas, USA
  • Kenneth Planas MD
    Staff Physician
    Department of Intensive Care
    Consorci Sanitari Integral
    Barcelona, Spain
  • Christian Prinz MD FESC
    Cardiologist
    Private Office for Cardiology
    Sögel, Niedersachsen, Germany
  • Sonal Sarkariya MD
    Internal Medicine
    St. Joesephs Hospital
    Orange County, California, USAFM10
  • Amir A Schricker MD MS FACC
    Assistant Professor
    Department of Medicine
    University of California
    San Diego, California, USA
  • Kevin S Shah MD
    Fellow, Department of Cardiology
    University of California
    Los Angeles, California, USA
  • 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 FAAN NFESC
    Professor, Department of Medical and Health Sciences
    Linköping University
    Linköping, Sweden
  • Wai Hong W Tang MD
    Professor of Medicine
    Cardiovascular Medicine, Heart
    and Vascular Institute
    Cleveland Clinic
    Cleveland, Ohio, USA
  • Rogier Van der Velde MD
    Resident
    Department of Cardiology
    Isala Klinieken
    Zwolle, Netherlands
  • Joel R Wilson MD
    Assistant Professor of Medicine
    and Radiology
    Director, Advanced Cardiovascular
    Imaging
    Department of Internal Medicine
    and Radiology
    University of California
    San Diego, California, USA
  • Yang Xue MD
    Cardiologist
    Department of Cardiology
    Kaiser Permanente
    Harbor City, California, USA
FM11Preface
It is clear to every healthcare practitioner that heart failure has become a worldwide epidemic. The scourge of obesity and heart disease and the aging 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. Our first book, Heart Failure: The Expert's Approach, provided timely and useful information. This new book, is a shorter, hands-on version, replete with useful algorithms and flowcharts that can be immediately utilized by the practicing physicians.
As in the textbook, Professor Pang from Northwestern University handled section 1 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.
Section 2 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.
Section 3 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.
Section 4 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.FM12
Section 5 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
FM13Acknowledgments
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 (P) Ltd. 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, lost their mother several years ago 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 MaiselFM14
FM15Acknowledgments
I would like to acknowledge the help and support of my parents Spyridon and Angeliki. Till the end of their life, they were close to me, ready to help in any initiative, any new project that I started. I also owe much to 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 am grateful 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, who asked me 10 years ago to organize and run the Heart Failure Unit at Attikon University Hospital. 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 FilippatosFM16