Heart Failure: Living with a Hurting Heart. James T. DeVries, MD Dartmouth-Hitchcock Medical Center. Outline. Definitions and scope of problem Diagnosing and classifying heart failure Approach to management of CHF Oral drug therapy (ACE-I, ARB, betablockers, aldosterone blockade, digoxin)
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James T. DeVries, MD
Dartmouth-Hitchcock Medical Center
Braunwald 8th Edition, 2001
A heart failure heart has a reduced ability to pump blood.
Valvular heart disease
Congenital heart defects
High or low hematocrit level
Obstructive Sleep ApneaRisk Factors for Heart Failure
CAD=coronary artery disease; LVH=left ventricular hypertrophy.
Heart Failure Patients in US
*Rich M. J Am Geriatric Soc. 1997;45:968–974.
American Heart Association. 2001 Heart and Stroke Statistical Update. 2000.
—George W. Bush, after being shown a map of Brazil by Brazilian president Luiz Inacio Lula da Silva, Brasilia, Brazil, Nov. 6, 2005
Ejection Fraction (EF)
ACC/AHA HF Stage1
NYHA Functional Class2
A At high risk for heart failure but without structural heart disease or symptoms of heart failure (eg, patients with hypertension or coronary artery disease)
B Structural heart disease but without symptoms of heart failure
CStructural heart disease with prior or current symptoms of heart failure
II Symptomatic with moderate exertion
III Symptomatic with minimal exertion
IV Symptomatic at rest
D Refractory heart failure requiring specialized interventions
1Hunt SA et al. J Am Coll Cardiol. 2001;38:2101–2113.
2New York Heart Association/Little Brown and Company, 1964. Adapted from: Farrell MH et al. JAMA. 2002;287:890–897.
Coronary artery disease
Adapted from Cohn JN. N Engl J Med. 1996;335:490–498.
Renin + Angiotensinogen
Salt & Water Retention
Type What it does
Improve Symptoms and NYHA Functional Class
Diuretics (water pills)
Angiotensin receptor blockers (ARB’s)Rational for Medications(Why does my doctor have me on so many pills??)
"During my service in the United States Congress, I took the initiative in creating the Internet"
Al Gore said when asked to cite accomplishments that separate him from another Democratic presidential hopeful, former Sen. Bill Bradley of New Jersey, during an interview with Wolf Blitzer on CNN on March 9, 1999.
Overview of Device Therapy
Sudden Cardiac Death (SCD)
Combination Pacemaker & Defibrillator