International journal of cardiology
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The prevalence of chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) increases substantially with age. The coexistence of COPD and CHF is common but often unrecognized in elderly patients. To avoid overlooking COPD in elderly patients with known CHF pulmonary function tests should be routinely obtained. ⋯ Physical conditioning is clearly an essential component of the management of elderly patients with COPD and CHF. The pharmacological management of patients with coexistent COPD and CHF should focus on not depriving these patients from long-term beta adrenergic blockade. Long-term beta adrenergic blockade has been repeatedly shown to improve survival in elderly patients with CHF due to LV systolic dysfunction and, contrary to conventional belief, is well tolerated by patients with COPD.
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Review Comparative Study
B-type natriuretic peptide assays for detecting heart failure in the elderly: same value as those in the younger?
Establishing a diagnosis of heart failure in elderly patients is notoriously difficult, especially in those who experience slowly progressive breathlessness, have multiple co-morbidity, and when, as in primary care echocardiography is not routinely (or readily) available. B-type natriuretic peptides measurements are useful in the diagnostic assessment of such patients, although the evidence in the very old (i.e. those aged 75 years and over) is less clear than for younger patients. Conflicting results in literature regarding B-type natriuretic peptides are mainly caused by differences in assays, the applied 'gold standard' for heart failure, and the population studied. ⋯ Cut-points differ widely when comparing studies in patients with acute versus chronic dyspnoea. In patients with acute dyspnoea age-dependent cut-points should be used, while in patients with chronic dyspnoea (that is, slowly progressive breathlessness) at least thresholds below which heart failure can be excluded seem rather independent of age. Especially in the primary care setting where elderly patients with slowly progressive dyspnoea are investigated, the excellent exclusionary capacities of B-type natriuretic peptides are of great help to select those that require echocardiography to establish or eventually reject a diagnosis of heart failure.
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Diastolic heart failure (DHF) is now firmly established as a significant contributor to the heart failure syndrome. However, compared to the better studied systolic dysfunction heart failure relatively little is known about this form of the syndrome. Epidemiological data have demonstrated that it is particularly important in the elderly likely reflecting the combination of several changes occurring in the myocardium occurring with advancing years, including progressive fibrosis and stiffening of the myocardium, the impact of hypertension over the years and the increased likelihood of ischaemic heart disease. This review will focus on the relevant aetiological factors in DHF, possible pathophysiological mechanisms and outline new and evolving therapeutic strategies for this problem.
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Letter Case Reports
Use of a high thoracic epidural analgesia for treatment of end-stage congestive heart failure secondary to coronary artery disease: effect of HTEA on CHF.
We present the case of a patient with end-stage congestive heart failure (NYHA class IV) secondary to ischemic cardiomyopathy despite maximally medical therapy, who needed to have a coronary artery bypass graft (CABG) surgery but whose risk was considered too high due to his deteriorating cardiac function. Cardiac sympathetic blockade by high thoracic epidural analgesia (HTEA) was added to stabilize the patient's critical condition before surgery. ⋯ The combination of HTEA treatment resulted in a rapid hemodynamic and clinical improvement and no serious catheter-related complications occurred. This case suggests that HTEA seems to be an effective and safe adjuvant therapeutics and can be used as a short-term bridge to CABG or cardiac transplantation in patients with end-stage congestive heart failure.