Cardiology

Answer 1 The most useful diagnostic test for evaluating CHF is 2-D echocardiography with Doppler flow studies. Echocardiography with Doppler study in patients with CHF helps to determine if the primary abnormality is pericardial, myocardial, or valvular and measures left ventricular ejection fraction to differentiate systolic from diastolic dysfunction. Neurohormones play a major role in the remodeling and progression of heart failure; they include norepinephrine, renin-angiotensin-aldosterone system, atrial natriuretic peptide, endothelin, antidiuretic hormone, interleukin-6, and tumor necrosis factor alpha. The most common cause of CHF today is coronary artery disease, accounting for two thirds of cases. The New York Heart Association classification is a functional status classification based on symptoms and does not correlate with ejection fraction. Although dyspnea is most commonly a symptom in systolic dysfunction, dyspnea from acute pulmonary edema can be a feature of diastolic dysfunction; thus, presentation alone does not help to differentiate the two. SUGGESTED READINGS 1. Consensus recommendations for the management of chronic heart failure. On behalf of the membership of the advisory council to improve outcomes nationwide in heart failure. Am J Cardiol 1999;83:1A-38A. 2. Gomberg-Maitland M, Baran DA, Fuster V. Treatment of congestive heart failure: guidelines for the primary care physician and the heart failure specialist. Arch Intern Med 2001;161:342-52. 3. Heart failure. In: Arky RA, Kettyle WM, Hatem CJ, editors. MKSAP 12: Cardiovascular medicine. Philadelphia: American College of Physicians - American Society of Internal Medicine; 2001:38-49. Click here to return to the questions

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