[Management of comorbidities in heart failure].
We will review some diseases that interfere most with management of heart failure : anemia, chronic renal failure, chronic pulmonary diseases, diabetes, atrial fibrillation/flutter, sleep apnea, angina, systemic arterial hypertension, rheumatic disease, depression and anticancer chemotherapy. We will retain principally their therapeutic implications. Anemia can be partially corrected by administration of intravenous iron or erythropoietin. Chronic renal failure requires adaptation of the treatment, in particular for drugs of the renin-angiotensin-aldosterone system. Chronic pulmonary diseases complicate diagnosis of heart failure and may lead to sub prescription of beta-blockers. Diabetes does not alter the usual recommendations for the treatment of heart failure but some hypoglycemic medications should be prescribed with caution. In the presence of atrial fibrillation or flutter, the main purpose of the treatment is to improve the quality of live and to diminish the thromboembolic risk ; it may be obtained by rhythm or rate control. Therapeutic approach of sleep apnea is based on optimal treatment of heart failure and weight loss. In the presence of angina, systemic arterial hypertension, rheumatic disease or depression, certain drugs usually prescribed are contraindicated or must be prescribed with caution. Finally, chemotherapy can be cardiotoxic and require careful monitoring of cardiac function.
Service de Cardiologie, C.H.U. Brugmann. beatrice.peperstraete@chu-brugmann.be
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Peperstraete
D018798:Anemia, Iron-Deficiency / Q000628:therapy; D000787:Angina Pectoris / Q000628:therapy; D001281:Atrial Fibrillation / Q000628:therapy; D001530:Belgium / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D003863:Depression / Q000628:therapy; D003920:Diabetes Mellitus / Q000628:therapy; D003937:Diagnosis, Differential; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D006973:Hypertension / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000628:therapy; D009369:Neoplasms / Q000628:therapy; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D011788:Quality of Life; D012216:Rheumatic Diseases / Q000628:therapy; D012891:Sleep Apnea Syndromes / Q000628:therapy; D016896:Treatment Outcome