Download Medical Management of Advanced Heart Failure

From: Medical Management of Advanced Heart Failure
JAMA. 2002;287(5):628-640. doi:10.1001/jama.287.5.628
Figure Legend:
Diagram indicating 2 × 2 table of hemodynamic profiles forpatients presenting with heart failure. Most patients can be classified ina
2-minute bedside assessment according to the signs and symptoms shown althoughin practice some patients may be on the border
between the warm-and-wet andcold-and-wet profiles. This classification helps guide initial therapy andprognosis for patients
presenting with advanced heart failure. Although mostpatients presenting with hypoperfusion also have elevated filling
pressures(cold and wet profile), many patients present
with
elevated
fillingMedical
pressureswithout major reduction in perfusion (warm and
Copyright
© 2002
American
Date
of download:
5/2/2017
wet profile).
Patients
presentingwith symptoms of Association.
heart failureAll
at rights
rest or
minimal
reserved. exertion without clinicalevidence of elevated filling
pressures or hypoperfusion (warm and dry profile)should be carefully evaluated to determine whether their symptoms result
From: Medical Management of Advanced Heart Failure
JAMA. 2002;287(5):628-640. doi:10.1001/jama.287.5.628
Figure Legend:
The step diagram demonstrates addition of therapies in relation tothe clinical severity of heart failure with reduced left ventricular
ejectionfraction. Angiotensin-converting enzyme (ACE) inhibitors are prescribed atevery level of disease severity, but they may have
to be withdrawn for symptomatichypotension or progressive renal dysfunction in 10% to 30% of patients approachingend-stage
disease, as indicated by the asterisk. Angiotensin receptor–blockingagents (ARBs) are a reasonable alternative for patients who
cannot tolerateACE inhibitors due to angioedema
or severe
cough
but theyMedical
are not appropriatefor patients intolerant to ACE
Copyright
© 2002
American
Date
of download:
5/2/2017
inhibitors
due to symptomatic
hypotension,renal failure,
or
hyperkalemia.
β-Adrenergic
blocking agents are prescribedfor patients
Association. All rights reserved.
with mild to moderate symptoms of heart failure, but they arenot initiated in patients with severe symptoms of heart failure