Internal Medicine

0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

318 Chronic Granulomatous Disease Chronic Heart Failure

■Prompt treatment of infection with parenteral antibiotics

■Surgical interventions including drainage of abscesses and resection

of infected tissue

specific therapy

■Prophylaxis with interferon-gamma helps decreases infections in

some patients

■Stem cell transplantation

➣A potential target for gene therapy

follow-up

n/a

complications and prognosis

■Life-threatening infections shorten life expectancy

Chronic Heart Failure.................................

JOHN R. TEERLINK, MD

history & physical

History

■Prior/current evidence of coronary artery disease (and related risk

factors, such as smoking, dyslipidemias, etc.), valvular disease, con-

genital heart disease, hypertension, myocarditis, thyroid disease,

alcohol or other cardiotoxic (cocaine, anthracyclines) ingestion or

exposure, infiltrative disease (amyloid, hemochromatosis, etc.)

■Family h/o cardiomyopathy, myocardial infarction

■Progressive increase in weight, peripheral edema, bloating, dyspnea

■Relatively gradual onset of symptoms

■Episodic symptoms suggestive of underlying ischemia

■Exacerbations often preceded by:

➣Excessive salt and/or fluid intake

➣Changes in therapy (or non-compliance)

➣Excessive activity

➣Progression of disease

➣Other precipitating causes (arrhythmias, infection, pulmonary

emboli)

Signs & Symptoms

■Dyspnea: exertional, orthopnea, paroxysmal nocturnal, “cardiac

asthma”