Best of heart failure

7 is that ischemia accounts for more than 50% of cases [ 8 ]. In s HF cases had antecedent hypertension. An increased ratio of HDL cholesterol is associated with increased risk of develo study, 49%of the subjects who had underlying sleep apnea hadH noncompliance with HF medications, poor diet including high and fatty foods, c an contribute to worsening of HF . Assessment of the Heart Failure Patient A number of criteria should be taken into consideration when with advanced HF including the number of previous admission tension, intolerance to angiotensin converting enzyme (ACE)/ blockers (ARB), and beta blockers, widening of the QRS co ness to biventricular pacing, worsening exertional tolerance, w tion, elevated HF biomarkers, and psychosocial factors. Common symptoms in HF patients include fatigue and d Dyspnea can range from shortness of breath with mild exerti paroxysmal nocturnal dyspnea. As such, patients report im ening in dyspnea marked by inability to walk a few block stairs as they move through the different classes of NY symptoms include lower extremity swelling, abdominal appetite, early satiety, drowsiness, and overall lack of energ ing and peripheral edema are common manifestations of flu more prevalent in the advanced HF population. Some o advanced HF include the following: need for inotropic sup medications, persistent hyponatremia, NYHA III–IV symp hospitalizations, and worsening renal function [ 6 , 11 ]. Sin disease, many patients adapt to their symptoms by decreasin duration of their activities of daily living. Because this occur of time, it is possible for HF patients to have advanced H significant symptoms or signs of HF. Physical exam findings associated with advanced HF inclu ular veno us distention, rales on auscultation, hypotension, a The presence of jugular venous pressure (JVP) in HF patients ing. Data suggest that JVP is a reasonably good assessment o pressures in chronic HF patients. Sensitivity and specificity fo predict a pulmonary capillary wedge pressure >18 approac 80%, respectively [ 12 ]. JVP is a good prognostic marker as w analysis, elevated JVP was associated with an increased risk fo HF and increased risk of overall mortality. Presence of an S3 associated with worse outcomes [ 13 ]. Although the presence of is suggestive of severe HF and volume overload, the absence o 1 Management of Advanced Heart Failure: An Overview Palliative Care Despite significant advancement in medical therapy to improve survival and quality of life, advanced HF still carries a poor prognosis. These patients usually are older and have underlying comorbidities, poor quality of life, and common complaints like dyspnea, depression, pain, and fatigue. Since many healthcare providers are seeing advanced HF patients, these patients often have a sense of uncertainty about prognosis and feel left out due to lack of communication. End of life transition and the whole process dealing with it is an unfamiliar territory for most. Furthermore, there is significant psychosocial burden on the family when a loved one is inflicted with HF. Palliative care strives to provide an improved quality of life and focuses on symptoms rather than therapy to prolong life. It takes into account the patient and family as a whole and looks to alleviate suffering. Palliative care is underutilized in this patient population [49]. References 1. Roger VL. Epidemiology of heart failure. Circ Res. 2013;113(6):646–59. https://doi. org/10.1161/CIRCRESHAHA.113.300268. 2. Massie BM, Shah NB. Evolving trends in the epidemiologic factors of heart failure: rationale for preventive strategies and comprehensive disease management. Am Heart J. 1997;133:703–12. 3. 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