ChesterCountyMedicineSummer2019 - 12

www.CHESTERCMS.org

Congestive Heart Failure,
An Overview
P A R T

2

BY DR. MIAN A. JAN, MD, FACC, FSCAI, AND ZARSHAWN JAN, MD
This article was a collaboration between Mian A. Jan, an interventional cardiologist
practicing in Chester County, and Zarshawn Jan, MD, who has finished medical school
and will be starting his residency.

To read Part 1 of this article, visit
https://www.nxtbook.com/hoffmann/CCMSMedicine/
ChesterCountyMedicineSpring2019/index.php#/24

Diagnostic Evaluation:
Congestive heart failure
Diagnostic evaluation
* Patient history
* Physical examination
1. Electrocardiography
2. Echocardiography (ejection fraction)
3. Chest x-ray
4. Blood tests
5. Radionuclide
6. Magnetic resonance
7. Computed tomography imaging
8. Cardiac catheterization with angiography
9. Myocardial Biopsy
FIGURE 8
The history and physical gives one a great clue to making
the diagnosis, other tests listed are confirmatory and/or
quantifying used to determine etiology and treatment.

FIGURE 7
Stages of Heart Failure:
* Stage A: Patients at high risk of developing left ventricular
dysfunction because of the presence of high risk conditions like
hypertension, coronary artery disease, and diabetes.
* Stage B: Patients who have developed structural heart disease
like myocardial infarction but still don't have any manifestation
of HF.
* Stage C: Patients who are now showing symptoms of heart
failure linked to structural heart disease.
* Stage D: Patients in this stage usually have advanced
structural heart disease and are displaying signs and symptoms
of heart failure even at rest.

12 CHESTER COUNT Y Medicine | SUMMER 2019

An echocardiogram is an excellent test, it is used to
determine systolic function and determine the ejection fraction
as well as the stiffness or diastolic function of the myocardium.
It gives accurate information regarding structural abnormalities
such as valvular heart disease and infiltrative diseases. Magnetic
Resonance Imaging (MRI) is used to asses both functional and
anatomical pathologies. Radionuclide stress tests gives us an
idea of the severity of coronary artery disease and multigated
acquisition (MUGA) scans can give us an exact Right and Left
Ventricular EF. CT scan use has also increased recently.
Blood tests detect biomarkers such as brain natriuretic
peptide (BNP) levels and are not only important for diagnoses
but can help monitor response to the treatment of HF.
Cardiac catheterization is used both for diagnostic
purposes, as well as the treatment of atherosclerotic arteries and
to do diagnostic biopsies.


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