Page 4 - Heart Failure Clinical Guidelines

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I. GENERAL HEART FAILURE PATIENT

A. Initial Evaluation for Heart Failure Patient
1. Detailed History and Physical

Special attention to the following
Cardiac Review of Systems
Growth Chart Review
Nutritional Assessment
Medical History
Surgical History
Family History of Heart Disease, Cardiomyopathy, Sudden Death, Transplantation
Fetal and Perinatal History
Hospitalizations
Medications
Newborn Screening

2. Laboratories, Tests

a) Imaging
CXR PA&LAT
Echocardiogram
MRI (standard when patients do not require sedation)
b) Rhythm
Exercise Test with Metabolic Cart (approximately age 8yo and greater)
Holter Monitor
Event Monitor (if palpitations, syncope)
c) Laboratories
CBC with Diff
CMP, Mg, Phos
BNP
Thyroid Function Tests
Iron Panel

B. Long-Term Medical Management
1. ACE-Inhibitors
Indications
a) treatment of symptomatic left ventricular dysfunction
b) treatment of asymptomatic left ventricular dysfunction (EF<50% or SF<23%)

2. Carvedilol/Beta Blockers
Indications
a) treatment of symptomatic left ventricular dysfunction
b) treatment of asymptomatic left ventricular dysfunction (EF<50% or SF<23%)