European Heart Journal Advance Access originally published online on January 28, 2005
European Heart Journal 2005 26(4):384-416; doi:10.1093/eurheartj/ehi044
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org
Executive summary of the guidelines on the diagnosis and treatment of acute heart failure
The Task Force on Acute Heart Failure of the European Society of Cardiology
Endorsed by the European Society of Intensive Care Medicine (ESICM) Authors/Task Force Members,
ESC Committee for Practice Guidelines (CPG),
Document Reviewers,
* Corresponding author. Chairperson: Markku S. Nieminen, Division of Cardiology, Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland. Tel.: +358 94717 22 00; fax: +358 9 4717 40 15. E-mail address: markku.nieminen@hus.fi
| The first 150 words of the full text of this article appear below. |
Preamble
Guidelines and Expert Consensus documents aim to present all the relevant evidence on a particular issue in order to help physicians to weigh the benefits and risks of a particular diagnostic or therapeutic procedure. They should be helpful in everyday clinical decision-making.
A great number of Guidelines and Expert Consensus Documents have been issued in recent years by the European Society of Cardiology (ESC) and by different organizations and other related societies. This profusion can put at stake the authority and validity of guidelines, which can only be guaranteed if they have been developed by an unquestionable decision-making process. This is one of the reasons why the ESC and others have issued recommendations for formulating and issuing Guidelines and Expert Consensus Documents.
In spite of the fact that standards for issuing good quality Guidelines and Expert Consensus Documents are well defined, recent surveys of Guidelines and Expert Consensus Documents published
1. Introduction
2. Epidemiology, aetiology, and clinical context
I. Definitions, diagnostic steps, instrumentation and monitoring of the patient with AHF
3. Definition and clinical classification of AHF
3.1. Definition
3.1.1. Killip classification.
3.1.2. Forrester classification.
3.1.3. ‘Clinical severity’ classification.
3.2. The clinical syndrome of AHF
3.2.1. Forward (left and right) AHF.
3.2.2. Left-heart backward failure.
3.2.3. Right-heart backward failure.
4. Pathophysiology of AHF
4.1. The vicious circle in the acute failing heart
4.2. Myocardial stunning
4.3. Hibernation
5. Diagnosis of AHF
5.1. Clinical evaluation
5.2. Electrocardiogram (ECG)
5.3. Chest X-ray and imaging techniques
5.4. Laboratory tests
5.5. Echocardiography
5.6. Other investigations
6. Goals of the treatment of AHF
6.1. Organization of the treatment of AHF
7. Instrumentation and monitoring of patients in AHF
7.1. Non-invasive monitoring
7.2. Invasive monitoring
7.2.1. Arterial line.
7.2.2. Central venous pressure lines.
7.2.3. Pulmonary artery catheter.
II. Treatment of AHF
8. General medical issues in the treatment of AHF
9. Oxygen and ventilatory assistance
9.1. Rationale for using oxygen in AHF
9.2. Ventilatory support without endotracheal intubation (non-invasive ventilation)
9.2.1. Rationale.
9.2.2. Evidence for the use of CPAP and NIPPV in left ventricular failure.
9.2.3. Conclusions.
9.3. Mechanical ventilation with endotracheal intubation in AHF
10. Medical treatment
10.1. Morphine and its analogues in AHF
10.2. Anticoagulation
10.3. Vasodilators in the treatment of AHF
10.3.1. Nitrates.
10.3.2. Sodium nitroprusside.
10.3.3. Nesiritide.
10.3.4. Calcium antagonists.
10.4. Angiotensin converting enzyme (ACE)-inhibitors in AHF
10.4.1. Indications.
10.4.2. Effects and mechanism of action.
10.4.3. Practical use.
10.5. Diuretics
10.5.1. Indications.
10.5.2. Effects and mechanisms of action.
10.5.3. Practical use.
10.5.4. Diuretic resistance.
10.5.5. Secondary effects, drug interactions.
10.5.6. New diuretic agents.
10.6. ß-blocking agents
10.6.1. Indications and rationale for ß-blocking agents.
10.6.2. Practical use.
10.7. Inotropic agents
10.7.1. Clinical indications.
10.7.2. Dopamine.
10.7.3. Dobutamine.
10.7.4. Practical use.
10.7.5. Phosphodiesterase inhibitors.
10.7.6. Levosimendan.
10.7.7. Vasopressor therapy in cardiogenic shock.
10.7.8. Cardiac glycosides.
11. Underlying diseases and co-morbidities in AHF
11.1. Coronary artery disease
11.2. Valvular disease
11.3. Management of AHF due to prosthetic valve thrombosis (PV T)
11.4. Aortic dissection
11.5. AHF and hypertension
11.6. Renal failure
11.7. Pulmonary diseases and bronchoconstriction
11.8. Arrhythmias and AHF
11.8.1. Bradyarrhythmias.
11.8.2. Supraventricular tachycardia (SVT).
11.8.3. Recommendations for treatment of supraventricular tachyarrhythmias in AHF.
11.8.4. Treatment of life-threatening arrhythmias.
11.9. Peri-operative AHF
12. Surgical treatment of AHF
12.1. AHF related to complications of AMI
12.1.1. Free wall rupture.
12.1.2. Post-infarction ventricular septal rupture (VSR).
12.1.3. Acute mitral regurgitation.
13. Mechanical assist devices and heart transplantation
13.1. Indication
13.1.1. Intra-aortic balloon counterpulsation (IABC).
13.1.2. Ventricular assist devices.
13.2. Heart transplantation
14. Summary comments
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