Internal Medicine

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

Chronic Heart Failure Chronic Kidney Disease 327

complications, myocardial perforation with pericardial tampon-

ade, VT/VF induced during placement. Chronic: Infection, inap-

propriate pacing, pacemaker syndrome, system failure (leads,

generator).

follow-up

During Treatment

■Often require weekly or bi-weekly visits during titration of medica-

tions, especially beta blockers

■Monitor electrolytes, especially potassium, and renal function

■Emphasize lifestyle changes such as reduced sodium intake, aerobic

exercise, compliance with medications, daily weights.

■Educate patient about pathophysiology of heart failure and reason

for medications (improves outcomes and compliance).

Routine

■Follow-up at least every 6 months

■Improved outcomes noted when followed by cardiologist, heart fail-

ure specialist.

■Repeat evaluation of LV function generally not indicated, unless

major intercurrent event or deterioration, although rechecking 6

months after beta blocker therapy may demonstrate significant

improvement.

■If ICD or CRT device in place, requires follow-up with qualified car-

diologist to interrogate and check settings

complications and prognosis

■Complications usually related to underlying pathophysiology, also

sudden death (about 50% of overall mortality) and death due to pro-

gressive heart failure

■50% 5-year mortality in some series

Chronic Kidney Disease...............................

ROBERT D. TOTO, MD

history & physical

History

■Infections, toxins, environment: hepatitis B and C, lead, mercury, sili-

con; Drugs: acetaminophen/paracetamol/caffeine combinations,