Heart failure clinics
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Heart failure clinics · Apr 2009
ReviewRole of the pulmonary artery catheter in diagnosis and management of heart failure.
The pulmonary artery catheter will likely earn a place in the history of medicine as one of the most useful tools that shaped our understanding and management of various diseases. An intense assessment of its application in nonacute and nonshock decompensated heart failure has been provided by the ESCAPE trial, a landmark investigation that showed an overall neutral impact of pulmonary artery catheter-guided therapy over therapy guided by clinical evaluation and judgment alone. The current guidelines reserve the use of a pulmonary artery catheter for the management of refractory heart failure and select conditions. The pulmonary artery catheter remains a useful instrument in clinical situations when clinical and laboratory assessment alone is insufficient in establishing the diagnosis and pathophysiologic condition, and in guiding effective, safe therapy.
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Heart failure clinics · Apr 2009
ReviewThe role of echocardiography in hemodynamic assessment in heart failure.
Echocardiography now is recommended as the most useful diagnostic test for routine evaluation and management of heart failure. This article reviews the role of echocardiography (M-mode, two-dimensional, spectral, and tissue Doppler) for qualitative and quantitative hemodynamic assessment of the patient who has heart failure. It highlights the echocardiographic parameters that have the most diagnostic and/or prognostic relevance for patients who have advanced heart failure. The importance of right heart failure and heart failure with preserved ejection fraction is increasingly recognized, and therefore the echocardiographic evaluation of these conditions is emphasized also.