The Evaluation and Follow-Up of a Heart Failure Patient

Extract

[...] Bibliography Harrison's Principles of Internal Medicine 16th.Ed Cecil Textbook of Medicine 22th.Ed Washington Manual of Medical Therapeutics 31st.Ed Chave e fechadura EVALUATION AND FOLLOW-UP OF THE HEART FAILURE PATIENT Routine Diagnostic Assessment LABORATORY TESTING. An extensive battery of laboratory tests is not required for most patients with heart failure. Routine testing should include a complete blood cell count (to detect anemia and systemic diseases with hematologic manifestations), measurement of renal function and electrolytes including magnesium (to exclude renal failure and to provide a baseline for subsequent therapy), liver function tests (to exclude accompanying liver pathology and provide a baseline), and blood glucose and lipid testing (to diagnose diabetes and dyslipidemia, both of which should be managed aggressively in heart failure patients). [...]

[...] There are two reasons to identify the coexistence of heart failure and coronary disease: first, to treat symptoms that may be due to ischemia and, second, to improve prognosis. A prudent approach is to subdivide heart failure patients into three groups: patients with clinical evidence of ongoing ischemia (active angina or a possible ischemic equivalent), patients who have had a prior MI but do not currently have angina, and patients who may or may not have underlying coronary disease. The first group of patients may be evaluated most expeditiously by coronary angiography because they stand to benefit in terms of symptoms and probably have more extensive ischemia. [...]

[...] Follow-Up Evaluation After the diagnosis of heart failure is confirmed and the initial evaluation is complete, there is little need for further testing beyond the laboratory tests (primarily renal function and electrolytes) necessary to monitor therapy. When the status of ventricular function is known, there are few indications for retesting. Exceptions are monitoring for transplantation and important changes in clinical status (e.g., marked deterioration in a patient previously known to have preserved left ventricular function, occurrence of new murmurs in conjunction with declining status). [...]

[...] Bibliography Harrison's Principles of Internal Medicine 16th.Ed Cecil Textbook of Medicine 22th.Ed Washington Manual of Medical Therapeutics 31st.Ed EVALUATION AND FOLLOW-UP OF THE HEART FAILURE PATIENT Routine Diagnostic Assessment LABORATORY TESTING. An extensive battery of laboratory tests is not required for most patients with heart failure. Routine testing should include a complete blood cell count (to detect anemia and systemic diseases with hematologic manifestations), measurement of renal function and electrolytes including magnesium (to exclude renal failure and to provide a baseline for subsequent therapy), liver function tests (to exclude accompanying liver pathology and provide a baseline), and blood glucose and lipid testing (to diagnose diabetes and dyslipidemia, both of which should be managed aggressively in heart failure patients). [...]

[...] ASSESSMENT OF LEFT VENTRICULAR FUNCTION Although heart failure is a syndrome with many pathogenic mechanisms, the most common are left ventricular systolic dysfunction and left ventricular diastolic dysfunction. In some patients, it may be nearly impossible to distinguish between these two forms of heart failure by clinical evaluation because both may present with the same symptoms and with only subtle differences on physical examination. It is essential to distinguish between these two entities, however, because they may require different diagnostic evaluations and different therapeutic approaches. [...]