0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53
320 Chronic Heart Failureedema (Kerley B lines, perivascular, subpleural effusion), alveo-
lar edema (“butterfly pattern”)
➣Electrocardiogram: ischemia/infarction; evidence of LVH, prior
MI
➣Echocardiogram(2-D with Doppler flow study): single most use-
ful diagnostic test; cardiac function, structure, wall motion and
valvular abnormalities
■Other Tests as Appropriate
➣Radionuclide ventriculogram (RVG; MUGA): cardiac function,
wall motion abnormalities
➣Exercise or pharmacologic stress testing: assess myocardial
ischemia risk
➣Cardiac catheterization: define coronary anatomy, possible
interventions;
➣Good distal targets, absent scintigraphic perfusion+radioactive
glucose uptake in “dead” region=hibernating myocardium;
good response to revascularization likely.
differential diagnosis
■Abnormal ventricular or atrial rhythm
■Chronic pulmonary emboli
■Chronic obstructive pulmonary disease
■Pneumonia
■Sepsis
■Cardiogenic shock
management
[also see Heart Failure Society Of America. Executive summary: HFSA
2006 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2006
Feb;12(1):10–38; Hunt SA, et al. ACC/AHA 2005 guideline update for the
diagnosis and management of chronic heart failure in the adult: a report
of the American College of Cardiology/American Heart Association Task
Force on Practice Guidelines (Writing Committee to Update the 2001
Guidelines for the Evaluation and Management of Heart Failure). J Am
Coll Cardiol. 2005 Sep 20;46(6):e1–82; and Swedberg K, et al. Guidelines
for the diagnosis and treatment of chronic heart failure: executive sum-
mary (update 2005): The Task Force for the Diagnosis and Treatment of
Chronic Heart Failure of the European Society of Cardiology. Eur Heart
J. 2005 Jun;26(11):1115–40.]
What to Do First
■Identify nature and severity of cardiac abnormality: combine history
and physical examination with echocardiographic and other diag-
nostic studies, as necessary