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ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012
[ Скачать с сервера (3.05Mb) ] 06.09.2012, 09:03
ESC Guidelines for the diagnosis and treatment
of acute and chronic heart failure 2012
Table of Contents
Abbreviations and acronyms . . . . . . . . . . . . . . . . . . . . . . . .1789
1. Preamble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1791
2. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1792
3. Definition and diagnosis . . . . . . . . . . . . . . . . . . . . . . . . .1792
3.1 Definition of heart failure . . . . . . . . . . . . . . . . . . . .1792
3.2 Terminology related to left ventricular ejection fraction .1792
3.3 Terminology related to the time-course of heart failure 1793
3.4 Terminology related to the symptomatic severity of heart
failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1793
3.5 Epidemiology, aetiology, pathophysiology, and natural
history of heart failure . . . . . . . . . . . . . . . . . . . . . . . . .1794
3.6 Diagnosis of heart failure . . . . . . . . . . . . . . . . . . . . .1794
3.6.1 Symptoms and signs . . . . . . . . . . . . . . . . . . . . .1794
3.6.2 General diagnostic tests in patients with suspected
heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1795
3.6.3 Essential initial investigations: echocardiogram,
electrocardiogram, and laboratory tests . . . . . . . . . . . .1795
3.6.4 Natriuretic peptides . . . . . . . . . . . . . . . . . . . . .1795
3.6.5 Chest X-ray . . . . . . . . . . . . . . . . . . . . . . . . . .1797
3.6.6 Routine laboratory tests . . . . . . . . . . . . . . . . . .1797
3.6.7 Algorithm for the diagnosis of heart failure . . . . . .1799
4. The role of cardiac imaging in the evaluation of patients with
suspected or confirmed heart failure . . . . . . . . . . . . . . . . . .1800
4.1 Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . .1800
4.1.1 Assessment of left ventricular systolic dysfunction .1800
4.1.2 Assessment of left ventricular diastolic dysfunction .1800
4.2 Transoesophageal echocardiography . . . . . . . . . . . . .1800
4.3 Stress echocardiography . . . . . . . . . . . . . . . . . . . . .1802
4.4 Cardiac magnetic resonance . . . . . . . . . . . . . . . . . . .1802
4.5 Single-photon emission computed tomography and
radionuclide ventriculography . . . . . . . . . . . . . . . . . . . . .1803
4.6 Positron emission tomography imaging . . . . . . . . . . . .1803
4.7 Coronary angiography . . . . . . . . . . . . . . . . . . . . . . .1803
4.8 Cardiac computed tomography . . . . . . . . . . . . . . . . .1803
5. Other investigations . . . . . . . . . . . . . . . . . . . . . . . . . . . .1803
5.1 Cardiac catheterization and endomyocardial biopsy . . .1803
5.2 Exercise testing . . . . . . . . . . . . . . . . . . . . . . . . . . .1804
5.3 Genetic testing . . . . . . . . . . . . . . . . . . . . . . . . . . .1804
5.4 Ambulatory electrocardiographic monitoring . . . . . . . .1804
6. Prognosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1804
7. Pharmacological treatment of heart failure with reduced
ejection fraction (systolic heart failure) . . . . . . . . . . . . . . . . .1804
7.1 Objectives in the management of heart failure . . . . . . .1804
7.2 Treatments recommended in potentially all patients with
systolic heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . .1804
7.2.1 Angiotensin-converting enzyme inhibitors and
beta-blockers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1804
7.2.2 Mineralocorticoid/aldosterone receptor
antagonists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1807
7.2.3 Other treatments recommended in selected patients
with systolic heart failure . . . . . . . . . . . . . . . . . . . . . .1809
7.2.4 Angiotensin receptor blockers . . . . . . . . . . . . . .1809
7.2.5 Ivabradine . . . . . . . . . . . . . . . . . . . . . . . . . . . .1809
7.2.6 Digoxin and other digitalis glycosides . . . . . . . . . .1810
7.2.7 Combination of hydralazine and isosorbide
dinitrate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1810
7.2.8 Omega-3 polyunsaturated fatty acids . . . . . . . . . .1810
7.3 Treatments not recommended (unproven benefit) . . . .1811
7.3.1 3-Hydroxy-3-methylglutaryl-coenzyme A reductase
inhibitors (‘statins’) . . . . . . . . . . . . . . . . . . . . . . . . . .1811
7.3.2 Renin inhibitors . . . . . . . . . . . . . . . . . . . . . . . .1811
7.3.3 Oral anticoagulants . . . . . . . . . . . . . . . . . . . . . .1811
7.4 Treatments not recommended (believed to cause harm) 1811
7.5 Diuretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1812
8. Pharmacological treatment of heart failure with ‘preserved’
ejection fraction (diastolic heart failure) . . . . . . . . . . . . . . . . .1812
9. Non-surgical device treatment of heart failure with reduced
ejection fraction (systolic heart failure) . . . . . . . . . . . . . . . . .1813
9.1 Implantable cardioverter-defibrillator . . . . . . . . . . . . .1813
9.1.1 Secondary prevention of sudden cardiac death . . . .1813
9.1.2 Primary prevention of sudden cardiac death . . . . .1813
9.2 Cardiac resynchronization therapy . . . . . . . . . . . . . . .1814
9.2.1 Recommendations for cardiac resynchronization
therapy where the evidence is certain . . . . . . . . . . . . .1815
9.2.2 Recommendations for cardiac resynchronization
therapy where the evidence is uncertain . . . . . . . . . . . .1815
10. Arrhythmias, bradycardia, and atrioventricular block in
patients with heart failure with reduced ejection fraction and
heart failure with preserved ejection fraction . . . . . . . . . . . . .1816
10.1 Atrial fibrillation . . . . . . . . . . . . . . . . . . . . . . . . . .1816
10.1.1 Rate control . . . . . . . . . . . . . . . . . . . . . . . . .1816
10.1.2 Rhythm control . . . . . . . . . . . . . . . . . . . . . . .1817
10.1.3 Thrombo-embolism prophylaxis . . . . . . . . . . . .1818
10.2 Ventricular arrhythmias . . . . . . . . . . . . . . . . . . . . .1818
10.3 Symptomatic bradycardia and atrioventricular block . .1819
1788 ESC Guidelines
11. Importance and management of other co-morbidity in heart
failure with reduced ejection fraction and heart failure with
preserved ejection fraction . . . . . . . . . . . . . . . . . . . . . . . . .1821
11.1 Heart failure and co-morbidities . . . . . . . . . . . . . . .1821
11.2 Anaemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1821
11.3 Angina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1821
11.4 Asthma: see chronic obstructive pulmonary disease . .1821
11.5 Cachexia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1821
11.6 Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1821
11.7 Chronic obstructive pulmonary disease . . . . . . . . . . .1821
11.8 Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1822
11.9 Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1822
11.10 Erectile dysfunction . . . . . . . . . . . . . . . . . . . . . . .1823
11.12 Gout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1823
11.13 Hyperlipidaemia . . . . . . . . . . . . . . . . . . . . . . . . .1823
11.14 Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . .1823
11.14 Iron deficiency . . . . . . . . . . . . . . . . . . . . . . . . . .1824
11.15 Kidney dysfunction and cardiorenal syndrome . . . . .1824
11.16 Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1824
11.17 Prostatic obstruction . . . . . . . . . . . . . . . . . . . . . .1824
11.18 Renal dysfunction . . . . . . . . . . . . . . . . . . . . . . . .1824
11.19 Sleep disturbance and sleep-disordered breathing . . .1824
12. Acute heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . .1824
12.1 Initial assessment and monitoring of patients . . . . . . .1825
12.2 Treatment of acute heart failure . . . . . . . . . . . . . . .1825
12.2.1 Pharmacological therapy . . . . . . . . . . . . . . . . . .1825
12.2.2 Non-pharmacological/non-device therapy . . . . . .1827
12.3 Invasive monitoring . . . . . . . . . . . . . . . . . . . . . . . .1831
12.3.1 Intra-arterial line . . . . . . . . . . . . . . . . . . . . . . .1831
12.3.2 Pulmonary artery catheterization . . . . . . . . . . . .1831
12.4 Monitoring after stabilization . . . . . . . . . . . . . . . . . .1831
12.5 Other in-patient assessments . . . . . . . . . . . . . . . . .1831
12.6 Readiness for discharge . . . . . . . . . . . . . . . . . . . . .1831
12.7 Special patient populations . . . . . . . . . . . . . . . . . . .1831
12.7.1 Patients with a concomitant acute coronary
syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1831
12.7.2 Isolated right ventricular failure . . . . . . . . . . . . .1832
12.7.3 Acute heart failure with ‘cardiorenal syndrome’ . .1832
12.7.4 Perioperative acute heart failure . . . . . . . . . . . .1832
12.7.5 Peripartum cardiomyopathy . . . . . . . . . . . . . . .1832
12.7.6 Adult congenital heart disease . . . . . . . . . . . . . .1832
13. Coronary revascularization and surgery, including valve
surgery, ventricular assist devices, and transplantation . . . . . . .1832
13.1 Coronary revascularization . . . . . . . . . . . . . . . . . . .1832
13.2 Ventricular reconstruction . . . . . . . . . . . . . . . . . . .1833
13.3 Valvular surgery . . . . . . . . . . . . . . . . . . . . . . . . . .1833
13.3.1 Aortic stenosis . . . . . . . . . . . . . . . . . . . . . . . .1833
13.3.2 Aortic regurgitation . . . . . . . . . . . . . . . . . . . . .1833
13.3.3 Mitral regurgitation . . . . . . . . . . . . . . . . . . . . .1833
13.4 Heart transplantation . . . . . . . . . . . . . . . . . . . . . .1834
13.5 Mechanical circulatory support . . . . . . . . . . . . . . . .1834
13.5.1 End-stage heart failure . . . . . . . . . . . . . . . . . . .1835
13.5.2 Acute heart failure . . . . . . . . . . . . . . . . . . . . .1835
14. Holistic management, including exercise training and
multidisciplinary management programmes, patient monitoring,
and palliative care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1836
14.1 Exercise training . . . . . . . . . . . . . . . . . . . . . . . . . .1836
14.2 Organization of care and multidisciplinary management
programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1837
14.3 Serial natriuretic peptide measurement . . . . . . . . . . .1838
14.4 Remote monitoring (using an implanted device) . . . . .1838
14.5 Remote monitoring (no implanted device) . . . . . . . .1838
14.6 Structured telephone support . . . . . . . . . . . . . . . . .1838
14.7 Palliative/supportive/end-of-life care . . . . . . . . . . . . .1838
15. Gaps in evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1838
15.1 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1838
15.2 Co-morbidity . . . . . . . . . . . . . . . . . . . . . . . . . . . .1838
15.3 Non-pharmacological, non-interventional therapy . . . .1839
15.4 Pharmacological therapy . . . . . . . . . . . . . . . . . . . .1839
15.5 Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1839
15.6 Acute heart failure . . . . . . . . . . . . . . . . . . . . . . . .1839
15.7 End-of-life care . . . . . . . . . . . . . . . . . . . . . . . . . . .1839
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1839

Категория: Рекомендации | Добавил: cardio | Теги: ESC Guidelines, crt, heart failure
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