1
|
Mouna E, Molka BB, Sawssan BT, Dhoha BS, Khouloud B, Nadia C, Fatma M, Fatma M, Mouna M, Nabila R, Faten HK, Mohamed A. Cardiothyreosis: Epidemiological, clinical and therapeutic approach. Clin Med Insights Cardiol 2023; 17:11795468231152042. [PMID: 36727115 PMCID: PMC9885034 DOI: 10.1177/11795468231152042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/03/2023] [Indexed: 01/29/2023] Open
Abstract
Introduction Cardiothyreosis corresponds to the cellular effects of free thyroid hormones on the vascular wall and the myocardium. We aim to describe the clinical, para-clinical and therapeutic aspects of cardiothyreosis and to detail prognostic factors. Methods We conducted a descriptive retrospective study at the Endocrinology-Diabetology Department of the Hedi Chaker University Hospital in Sfax-Tunisia. We collected medical records of 100 patients with cardiothyreosis between January 1999 and December 2019. We included patients with cardiothyreosis who underwent adequate cardiac evaluation. We excluded patients with cardiac abnormalities related to conditions other than hyperthyroidism, patients who died and patients without cardiothyreosis. Results We included 100 adult patients (43 men and 57 women). The mean age was 49.3 ±12.9 years (20-79 years). The diagnosis of cardiothyreosis was concomitant with that of hyperthyroidism in 72% of cases. Weight loss and palpitations were the two most frequently reported signs in 91% of cases each. Hypertension was systolic in 15 patients. The average heart rate was 103.1 beats/min (52-182 bpm). The mean TSH and FT4 levels were 0.042 μIU/ml and 59.6 pmol/l, respectively. Rhythm disorders and heart failure were the most common cardiac complications with 81 and 56 cases, respectively. Cardiac ultrasound showed dilatation of the left atrium in 28.3% of patients. Pulmonary arterial hypertension was present in 43% of cases. 57 patients had been treated with benzylthiouracil at a mean dose of 157.45 mg/day. Radical treatment with radioactive iodine was indicated in 81 patients. The evolution of cardiothyreosis was favourable in 58 patients. Conclusion Cardiothyreosis is a serious complication of hyperthyroidism. Future prospective studies will be of great help to better characterise and manage cardiothyreosis.
Collapse
Affiliation(s)
- Elleuch Mouna
- Elleuch Mouna, Department of Endocrinology
Diabetology, Hedi Chaker hospital, University of Sfax, Sfax, 3089, Tunisia.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Takahashi M, Kondo T, Yamasaki G, Sugimoto M, Kuse A, Morichika M, Nakagawa K, Ueno Y. An autopsy case of thyroid storm associated with chronic lymphocytic thyroiditis. Leg Med (Tokyo) 2019; 44:101624. [PMID: 32259690 DOI: 10.1016/j.legalmed.2019.101624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/15/2019] [Accepted: 09/03/2019] [Indexed: 11/17/2022]
Abstract
A Japanese woman in her 30s was found dead on a mattress. She had had fever, cough, and dyspnea for about 2 weeks. Gross examination at autopsy revealed slight enlargement of the thyroid gland and histopathological examination resulted in a diagnosis of chronic lymphocytic thyroiditis. The concentration of triiodothyronine in the cadaveric blood was extraordinarily high, whereas that of thyroid stimulating hormone was below the detection limit. Autoimmune antibodies against thyroid tissue were positive. The cause of death was assumed to be congestive heart failure caused by thyroid storm associated with chronic lymphocytic thyroiditis. Systemic histopathological examination of tissues and postmortem biochemistry can enable a diagnosis in medicolegal autopsies.
Collapse
Affiliation(s)
- Motonori Takahashi
- Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan.
| | - Takeshi Kondo
- Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Gentaro Yamasaki
- Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Marie Sugimoto
- Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Azumi Kuse
- Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Mai Morichika
- Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Kanako Nakagawa
- Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Yasuhiro Ueno
- Division of Legal Medicine, Department of Community Medicine and Social Health Science, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| |
Collapse
|
3
|
Filipescu GA, Solomon OA, Clim N, Milulescu A, Boiangiu AG, Mitran M. Molar pregnancy and thyroid storm - literature review. ARS MEDICA TOMITANA 2017. [DOI: 10.1515/arsm-2017-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Molar pregnancies results from a tainted fertilization process. Trophoblastic thyroidian hyper function is an unusual complication of a molar pregnancy. The degree of thyroid stimulation and the severity of clinical hyperthyroidism is directly proportional to HCG concentration. Human chorionic gonadotrophin is almost identical with TSH, luteinizing hormone (LH) and follicle-stimulating hormone, this analogy in the structure will cause cross-reactivity with their receptors. Hyperthyroid status can vary from asymptomatic hyper function to thyroid storm. Dilation and curettage represents the treatment for hyperthyroidism in molar pregnancy. Awareness of this condition is important for diagnosis and treatment.
Collapse
Affiliation(s)
- G. A. Filipescu
- University of Medicine and Pharmacy “Carol Davila”, Bucharest , Romania
- Department of Obstetrics and Gynaecology, Emergency University Elias Hospital, Bucharest , Romania
| | - Oana Alina Solomon
- Department of Obstetrics and Gynaecology, Emergency University Elias Hospital, Bucharest , Romania
| | - Nicoleta Clim
- Department of Obstetrics and Gynaecology, Emergency University Elias Hospital, Bucharest , Romania
| | - Amelia Milulescu
- University of Medicine and Pharmacy “Carol Davila”, Bucharest , Romania
- Department of Obstetrics and Gynaecology, Emergency University Elias Hospital, Bucharest , Romania
| | | | - M. Mitran
- University of Medicine and Pharmacy “Carol Davila”, Bucharest , Romania
- Department of Obstetrics and Gynaecology, “Panait Sirbu” Hospital, Bucharest , Romania
| |
Collapse
|
4
|
Abstract
Aging is characterized by heterogeneity, both in health and illness. Older adults with heart failure often have preserved ejection fraction and atypical and delayed clinical manifestations. After diagnosis of heart failure is established, a cause should be sought. The patient's comorbidities may provide clues. An elevated jugular venous pressure is the most reliable clinical sign of fluid volume overload and should be carefully evaluated. Left ventricular ejection fraction must be determined to assess prognosis and guide therapy. These 5 steps, namely, diagnosis, etiologic factor, fluid volume, ejection fraction, and therapy for heart failure may be memorized by mnemonic: DEFEAT-HF.
Collapse
Affiliation(s)
- Gurusher Panjrath
- Department of Medicine, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 8-416, Washington, DC 20037, USA; Inova Heart and Vascular Institute, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Ali Ahmed
- Department of Medicine, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 8-416, Washington, DC 20037, USA; Center for Health and Aging, Veterans Affairs Medical Center, 50 Irving Street NW, Washington, DC 20422, USA; Department of Medicine, University of Alabama at Birmingham, 933 19th Street South, CH19 201, Birmingham, AL 35294, USA.
| |
Collapse
|
5
|
Hübner NS, Merkle A, Jung B, von Elverfeldt D, Harsan LA. Analysis of left ventricular function of the mouse heart during experimentally induced hyperthyroidism and recovery. NMR IN BIOMEDICINE 2015; 28:116-123. [PMID: 25394338 DOI: 10.1002/nbm.3233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 10/06/2014] [Accepted: 10/07/2014] [Indexed: 06/04/2023]
Abstract
Many of the clinical manifestations of hyperthyroidism are due to the ability of thyroid hormones to alter myocardial contractility and cardiovascular hemodynamics, leading to cardiovascular impairment. In contrast, recent studies highlight also the potential beneficial effects of thyroid hormone administration for clinical or preclinical treatment of different diseases such as atherosclerosis, obesity and diabetes or as a new therapeutic approach in demyelinating disorders. In these contexts and in the view of developing thyroid hormone-based therapeutic strategies, it is, however, important to analyze undesirable secondary effects on the heart. Animal models of experimentally induced hyperthyroidism therefore represent important tools for investigating and monitoring changes of cardiac function. In our present study we use high-field cardiac MRI to monitor and follow-up longitudinally the effects of prolonged thyroid hormone (triiodothyronine) administration focusing on murine left ventricular function. Using a 9.4 T small horizontal bore animal scanner, cinematographic MRI was used to analyze changes in ejection fraction, wall thickening, systolic index and fractional shortening. Cardiac MRI investigations were performed after sustained cycles of triiodothyronine administration and treatment arrest in adolescent (8 week old) and adult (24 week old) female C57Bl/6 N mice. Triiodothyronine supplementation of 3 weeks led to an impairment of cardiac performance with a decline in ejection fraction, wall thickening, systolic index and fractional shortening in both age groups but with a higher extent in the group of adolescent mice. However, after a hormonal treatment cessation of 3 weeks, only young mice are able to partly restore cardiac performance in contrast to adult mice lacking this recovery potential and therefore indicating a presence of chronically developed heart pathology.
Collapse
Affiliation(s)
- Neele Saskia Hübner
- Department of Radiology, Medical Physics, University Medical Center Freiburg, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany
| | | | | | | | | |
Collapse
|
6
|
Abstract
We report on a 44-year-old woman presenting with chest pain and dyspnoea without previous stress-related events. By means of echocardiography severe left ventricular dysfunction and wall motion abnormalities resembling stress-induced cardiomyopathy (Tako Tsubo) were seen. Laboratory investigation revealed thyrotoxicosis and elevated cardiac markers. Six days after starting medical treatment, complete restoration of the left ventricular function was observed. The transient left ventricular dysfunction was induced by thyrotoxicosis resembling stress-induced cardiomyopathy that resolved completely after medical treatment.
Collapse
Affiliation(s)
- E Bird-Lake
- , Nilda Pintostraat #29, 1103, MK, Amsterdam, the Netherlands,
| |
Collapse
|
7
|
Yang JH, Jang HW, Park SJ, Park SW. Transient left ventricular systolic dysfunction with thrombus and subsequent cardioembolic stroke in short-term overt hypothyroidism. Cardiology 2011; 119:38-42. [PMID: 21811072 DOI: 10.1159/000329839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 05/26/2011] [Indexed: 11/19/2022]
Abstract
A 57-year-old woman was referred for cardiomegaly on a chest X-ray taken during thyroxine withdrawal for radioiodine therapy after total thyroidectomy. Baseline transthoracic echocardiography showed left ventricular (LV) wall motion abnormalities and an LV apical mural thrombus. Coronary angiography revealed normal epicardial coronary arteries. Despite anticoagulation treatment, the patient developed abrupt aphasia, agraphia and acalculia. The distal branch of the inferior segmental branch on the left middle cerebral artery was not well visualized on magnetic resonance angiography. Three days later, the patient had made a near full neurological recovery. After 4 weeks of anticoagulation therapy, the apical mural thrombus and wall motion abnormalities resolved. This is the first reported case in the medical literature of transient LV systolic dysfunction with thrombus and subsequent cardioembolic stroke in a patient with short-term overt hypothyroidism.
Collapse
Affiliation(s)
- Jeong Hoon Yang
- Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | |
Collapse
|
8
|
Kantor PF, Mertens LL. Clinical practice: heart failure in children. Part I: clinical evaluation, diagnostic testing, and initial medical management. Eur J Pediatr 2010; 169:269-79. [PMID: 19707788 DOI: 10.1007/s00431-009-1024-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 06/22/2009] [Indexed: 02/02/2023]
Abstract
Current evidence suggests that almost half of all children with cardiomyopathy and symptomatic heart failure will die or require a cardiac transplant within 5 years of diagnosis. The recognition, diagnostic assessment, and treatment of heart failure in children are therefore challenging undertakings, to say the least. It involves an assessment of cardiac appearance and function, adaptation of the child as a whole, and a diagnostic approach that evaluates many possible root causes. This review is intended to assist the practicing pediatrician and cardiologist by providing a framework for this diagnostic assessment and to give an overview of the treatment options available for children with heart failure. In this first part, we will focus on clinical evaluation, diagnostic testing, and initial medical management. In the second part of this series, the maintenance treatment and treatment options applicable when medical treatment is insufficient will be addressed.
Collapse
Affiliation(s)
- Paul F Kantor
- Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | | |
Collapse
|
9
|
El Hattaoui M, Charei N, Mouniri M, Diouri A. [Cardiothyrotoxicosis in the young adult in Marrakech. A report of 36 cases]. Ann Cardiol Angeiol (Paris) 2009; 58:135-138. [PMID: 18937925 DOI: 10.1016/j.ancard.2008.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2008] [Accepted: 07/13/2008] [Indexed: 05/26/2023]
Abstract
Thyrotoxicosis is underdiagnosed because of its low occurrence in series from Africa. The aim of this study was to evaluate the frequency, the demographic data, and the etiological aspects of thyrotoxicosis among hyperthyroidy. Thirty-six patients with thyrotoxicosis (group I) gathered during a period of four years was analysed, as well as 180 hyperthyroidy cases (group II). Cardiothyrotoxicosis was observed with a frequency of 16.6%. The mean age was respectively of 44.5+/-13.3 versus 32.8+/-11.4 years (p<10(-6)). Cardiothyrotoxicosis was related to multinodular goitres (18 cases), a Basedow disease (14 cases), a toxic adenoma (four cases), while the principal cause of hyperthyroidy was toxic adenoma followed by the Basedow disease (72 cases, 40%). Different modes of presentation of cardiothyrotoxicosis were found: cardiac heart failure in 27 cases (75%), permanent atrial fibrillation in 22 cases (61.1%), atrial flutter in two cases, coronary insufficiency in four cases, ventricular extrasystoli (trigeminism) in two cases, second auriculoventricular block in two cases, dilated myocardiopathy in 10 cases (27.7%), ischemic myocardiopathy in four cases, severe mitral regurgitation in one case. This study confirms the relative frequency of cardiothyrotoxicosis, the proportionally weak place of Basedow disease among hyperthyroidy's causes, and role of associated cardiac disease to the hyperthyroid.
Collapse
Affiliation(s)
- M El Hattaoui
- Cardiology Department, CHU Mohammed-VI, Marrakech, Maarif, Casablanca, Morocco.
| | | | | | | |
Collapse
|
10
|
Abstract
The symptoms and signs of heart failure can occur in the setting of an increased cardiac output and has been termed 'high output heart failure'. An elevated cardiac output with clinical heart failure is associated with several diseases including chronic anaemia, systemic arterio-venous fistulae, sepsis, hypercapnia and hyperthyroidism. The underlying primary physiological problem is of reduced systemic vascular resistance either due to arterio-venous shunting or peripheral vasodilatation. Both scenarios can lead to a fall in systemic arterial blood pressure and neurohormonal activation leading to overt clinical heart failure. In contrast to low output heart failure, clinical trial data in this area are lacking. The use of conventional therapies for heart failure, such as angiotensin converting enzyme inhibitors, angiotensin receptor blockers and certain beta-blockers with vasodilatory properties, is likely to further reduce systemic vascular resistance resulting in deterioration. The condition, although uncommon, is often associated with a potentially correctable aetiology. In the absence of a remediable cause, therapeutic options are very limited but include dietary restriction of salt and water combined with judicious use of diuretics. Vasodilators and beta-adrenoceptor positive inotropes are not recommended.
Collapse
Affiliation(s)
- P A Mehta
- Clinical Cardiology, National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, UK.
| | | |
Collapse
|
11
|
Wildemberg LEA, Sousa LLD, Fonseca LPMD, Souza MVLD. [Reversible dilated cardiomyopathy related to hyperthyroidism]. ACTA ACUST UNITED AC 2009; 51:1533-8. [PMID: 18209898 DOI: 10.1590/s0004-27302007000900018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 02/02/2007] [Indexed: 02/03/2023]
Abstract
Heart failure is one of the most known complications of hyperthyroidism, more commonly high-output heart failure, but some patients may develop dilated cardiomyopathy with low ejection fraction. We report a 35-year-old man, with hyperthyroidism, atrial fibrillation, and severe heart failure with 43% of ejection fraction. After the definitive treatment of the hyperthyroidism with radioiodine, heart failure was reverted, with symptomatic improvement and echocardiographic normalization including a normal ejection fraction (69%). There are several cases of reversion of heart failure due to hyperthyroidism treatment, but most of them with a high-output heart failure. Mechanisms by which hyperthyroidism can lead to heart failure and its treatment are discussed. We conclude that treatment of hyperthyroidism may reverse this thyroid related heart failure, even in severe cases with systolic dysfunction.
Collapse
Affiliation(s)
- Luiz Eduardo A Wildemberg
- Serviço de Endocrinologia, Instituto Estadual de Diabetes e Endocrinologia Luis Capriglione, Rio de Janeiro, RJ.
| | | | | | | |
Collapse
|
12
|
Abstract
The most recognizable features of hyperthyroidism are those that result from the effects of triiodothyronine (T3) on the heart and cardiovascular system: decreased systemic vascular resistance and increased resting heart rate, left ventricular contractility, blood volume, and cardiac output. Although these measures of cardiac performance are enhanced in hyperthyroidism, the finding of clinical cardiac failure can be somewhat paradoxical. About 6% of thyrotoxic individuals develop symptoms of heart failure, but less than 1% develop dilated -cardiomyopathy with impaired left ventricular systolic function. Heart failure resulting from thyrotoxicosis is due to a tachycardia-mediated mechanism leading to an increased level of cytosolic calcium during diastole with reduced ventricular contractility and diastolic dysfunction, often with tricuspid regurgitation. Pulmonary artery hypertension in thyrotoxicosis is gaining awareness as a cause of isolated right-sided heart failure. In both cases, older individuals are more likely to be affected. Treatment needs to be directed at management of the acute cardiovascular complications, control of the heart rate, and thyroid-specific therapy to restore a euthyroid state that will lead to resolution of the signs and symptoms of heart failure.
Collapse
|
13
|
Ahmed A. DEFEAT heart failure: clinical manifestations, diagnostic assessment, and etiology of geriatric heart failure. Heart Fail Clin 2007; 3:389-402. [PMID: 17905376 DOI: 10.1016/j.hfc.2007.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Aging is characterized by heterogeneity, both in health and in disease. Older adults who have heart failure (HF) often have atypical and delayed clinical manifestations and many have diastolic HF. The assessment and management of HF in older adults may be simplified by a 5-step process called DEFEAT HF: (1) establish a clinical Diagnosis of HF; (2) establish an Etiology for HF, preferably in collaboration with a cardiologist; (3) determine Fluid status and achieve euvolemia; (4) determine left ventricular Ejection frAction; and (5) provide evidence-based Therapy.
Collapse
Affiliation(s)
- Ali Ahmed
- University of Alabama at Birmingham, Birmingham, AL 35294-2041, USA.
| |
Collapse
|
14
|
Erturk E, Bostan H, Geze S, Saracoglu S, Erciyes N, Eroglu A. Total intravenous anesthesia for evacuation of a hydatidiform mole and termination of pregnancy in a patient with thyrotoxicosis. Int J Obstet Anesth 2007; 16:363-6. [PMID: 17459690 DOI: 10.1016/j.ijoa.2006.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Revised: 09/01/2006] [Accepted: 12/01/2006] [Indexed: 02/07/2023]
Abstract
Clinical hyperthyroidism is found in approximately 5% of women with a hydatidiform mole, as human chorionic gonadotropin secreted by molar tissue is structurally similar to thyroid-stimulating hormone. A hydatidiform mole occasionally presents with a co-existing viable fetus. Surgical evacuation may be indicated for significant hemorrhage or preeclampsia. Perioperative management in the presence of hyperthyroidism may be complicated by a thyroid storm. We report a case of total intravenous anesthesia with propofol and remifentanil, combined with an esmolol infusion, to control sympathetic hyperactivity during surgery.
Collapse
Affiliation(s)
- E Erturk
- Karadeniz Technical University, Medical Faculty, Department of Anesthesiology, Trabzon, Turkey.
| | | | | | | | | | | |
Collapse
|
15
|
Ahmed A. Clinical manifestations, diagnostic assessment, and etiology of heart failure in older adults. Clin Geriatr Med 2007; 23:11-30. [PMID: 17126753 DOI: 10.1016/j.cger.2006.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aging is characterized by heterogeneity, both in health and in dis-ease. Older adults who have heart failure (HF) often have a typical and delayed clinical manifestations and many have diastolic HF. The assessment and management of HF in older adults may be simplified by a 5-step process called DEFEAT HF: (1) Establish a clinical Diagnosis of HF; (2) Establish an Etiology for HF, preferably in collaboration with a cardiologist; (3) Determine Fluid status and achieve euvolemia; (4) Determine left ventricular Ejection frAction; and (5) Provide evidence-based Therapy.
Collapse
Affiliation(s)
- Ali Ahmed
- Department of Medicine, School of Medicine, Geriatric Heart Failure Clinic, Center for Aging, and Center for Heart Failure Research, University of Alabama at Birmingham, 1530 3rd Avenue South, CH19-219, Birmingham, AL 35294-2041, USA.
| |
Collapse
|