We propose that stage D advanced heart failure be defined as the presence of progressive and/or persistent severe signs and symptoms of heart failure despite optimized medical, surgical, and device therapy. Importantly, the progressive decline should be primarily driven by the heart failure syndrome.
First-line diuretic therapy is a loop diuretic (furosemide, bumetanide, torsemide) in the lowest effective dose, either once or twice a day — although it can be used up to 3-4 times a day — depending on the individual response and renal function.
Mitral regurgitation and aortic stenosis are the most common causes of heart failure, secondary to valvar disease. Mitral regurgitation (and aortic regurgitation) leads to volume overload (increased preload), in contrast with aortic stenosis, which leads to pressure overload (increased afterload).
Cardiovascular diagnostic and screening tests can provide a wealth of information about the electrical activity of the heart, heartbeat rhythm, how well blood is pumping through the heart’s chambers and valves, how easily blood is flowing through the coronary arteries to the heart muscle, and whether there are tumors