History

Fact Explanation
Asymptomatic [4] Symptoms manifest when it progresses to congestive cardiac failure, till then patients are asymptomatic. Symptoms also manifest due to underlying disease which caused cardiomegaly [4]
Dyspnoea [4] This is related to pulmonary venous congestion which results from left ventricular dysfunction associated with congestive cardiac failure. [4]
orthopnoea, Paroxymal nocturnal dyspnoea [4] This is related to pulmonary venous congestion which results from left ventricular dysfunction associated with congestive cardiac failure. [4]
Ankle swelling [4] This is due to increased fluid accumulation which occurs due to activation of various neuroendocrine mechanisms in congestive cardiac failure [4]
Weight gain [4] This is due to increased fluid accumulation which occurs due to activation of various neuroendocrine mechanisms in congestive cardiac failure [4]
Palpitations [5] When the artia and ventricles stretch various arrhythmia result such as atrial fibrillation, ventricular arrhythmias which is sensed as pounding of the heart. Sudden cardiac death also occur [5]
Exertional chest pain [6] If the underlying cause for cardiomegaly is due to coronary artery disease, patient may give a history of exertional chest pain [6]
References
  1. RAMARAJ R., SORRELL V. L.. Peripartum cardiomyopathy: Causes, diagnosis, and treatment. Cleveland Clinic Journal of Medicine [online] December, 76(5):289-296 [viewed 07 July 2014] Available from: doi:10.3949/ccjm.76a.08004
  2. SHETH J. J., ANKLESHWARIA C. M., MISTRI M. A., NANAVATY N., MEHTA S. J.. Splenomegaly, Cardiomegaly, and Osteoporosis in a Child with Gaucher Disease. Case Reports in Pediatrics [online] 2011 December, 2011:1-4 [viewed 07 July 2014] Available from: doi:10.1155/2011/564868
  3. SHAH B. N., RUBENS M.. Giant left atrium: a forgotten cause of cardiomegaly. Postgraduate Medical Journal [online] December, 88(1045):673-674 [viewed 07 July 2014] Available from: doi:10.1136/postgradmedj-2012-131030
  4. MCMURRAY J. J. HEART FAILURE: Epidemiology, aetiology, and prognosis of heart failure. [online] 2000 May, 83(5):596-602 [viewed 07 July 2014] Available from: doi:10.1136/heart.83.5.596
  5. BURKE A.. Role of SCN5A Y1102 Polymorphism in Sudden Cardiac Death in Blacks. Circulation [online] 2005 August, 112(6):798-802 [viewed 05 September 2014] Available from: doi:10.1161/CIRCULATIONAHA.104.482760
  6. SHI KAIYAO, ZHAO WANKE, CHEN YUN, HO WANTING, YANG PING, ZHAO ZHIZHUANG. Cardiac hypertrophy associated with myeloproliferative neoplasms in JAK2V617F transgenic mice. Array [online] 2014 December [viewed 07 July 2014] Available from: doi:10.1186/1756-8722-7-25
  7. GRIMM A. F., KUBOTA R., WHITEHORN W. V.. Properties of Myocardium in Cardiomegaly. Circulation Research [online] 1963 January, 12(1):118-124 [viewed 07 July 2014] Available from: doi:10.1161/01.RES.12.1.118

Examination

Fact Explanation
Dependent edema [1] [3] This is due to increased fluid accumulation which occurs due to activation of various neuroendocrine mechanisms in congestive cardiac failure [1]
Increased jugular venous pressure [1] [3] Systemic venous congestion related to congestive cardiac failure results in increased jugular venous pressure [1]
Cardiomegaly [3] [7] As a result of enlargement of the heart, the apex of the heart may be displaced from it's usual position which is considered as just medial to the left mid clavicular line in the 5th intercostal space. [3] [7]
Hepatomegaly [1] [3] Systemic venous congestion related to congestive cardiac failure results in increased jugular venous pressure [1]
Ascitis [1] [3] This is due to increased fluid accumulation which occurs due to activation of various neuroendocrine mechanisms in congestive cardiac failure [1]
Fine end inspiratory crepitations [1] [3] This is related to pulmonary venous congestion which results from left ventricular dysfunction associated with congestive cardiac failure. [1] [3]
Irregular pulse [2] When the artia and ventricles stretch various arrhythmia result such as atrial fibrillation, ventricular arrhythmias which is sensed as pounding of the heart. Sudden cardiac death also occur [2]
High blood pressure [3] If the underlying cause of cardiomegaly is hypertensive heart disease, this could be found [3]
Heart murmurs [4] If the underlying cause is due to valvular heart disease, murmurs can be heard. [5]
Pallor [5] [6] If the underlying cause for cardiomegaly is anaemia by high output cardiac failure, pallor can be observed [5]
References
  1. MCMURRAY J. J. HEART FAILURE: Epidemiology, aetiology, and prognosis of heart failure. [online] 2000 May, 83(5):596-602 [viewed 07 July 2014] Available from: doi:10.1136/heart.83.5.596
  2. BURKE A.. Role of SCN5A Y1102 Polymorphism in Sudden Cardiac Death in Blacks. Circulation [online] 2005 August, 112(6):798-802 [viewed 05 September 2014] Available from: doi:10.1161/CIRCULATIONAHA.104.482760
  3. AHMED A. DEFEAT - Heart Failure: A Guide to Management of Geriatric Heart Failure by Generalist Physicians Minerva Med [online] 2009 Feb, 100(1):39-50 [viewed 07 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2914573
  4. BRUCE C. J., CONNOLLY H. M.. Right-Sided Valve Disease Deserves a Little More Respect. Circulation [online] December, 119(20):2726-2734 [viewed 07 July 2014] Available from: doi:10.1161/​CIRCULATIONAHA.108.776021
  5. HEGDE N, RICH MW, GAYOMALI C. The Cardiomyopathy of Iron Deficiency Tex Heart Inst J [online] 2006, 33(3):340-344 [viewed 07 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592266
  6. MEHTA P.A., DUBREY S.W.. High output heart failure. QJM [online] 2009 February, 102(4):235-241 [viewed 07 July 2014] Available from: doi:10.1093/qjmed/hcn147
  7. GRIMM A. F., KUBOTA R., WHITEHORN W. V.. Properties of Myocardium in Cardiomegaly. Circulation Research [online] 1963 January, 12(1):118-124 [viewed 07 July 2014] Available from: doi:10.1161/01.RES.12.1.118

Differential Diagnoses

Fact Explanation
Dilated cardiomyopathy [3] In dilated cardiomyopathy, there's dilatation of all 4 chambers of the heart which results in enlargement of the heart.[3]
hypertensive heart disease [2] Hypertension for a long period of time also causes cardiac hypertrophy and enlargement by increased work load on the heart [2]
Coronary artery disease [4] Atherosclerosis is the commonest cause for narrowing of coronary arteries and results in ischemia to the cardiac muscle and enlargement [4]
valvular heart disease [7] Valvular disease either regurgitation or stenosis which cause volume overload and pressure overload respectively and cause cardiac enlargement [7]
Peripartum cardiomyopathy [5] There's enlargement of the heart during pregnancy due to increased work load and usually returns to normal spontaneously by the end of peripartum period [5]
Alcohol or cocaine abuse [3] Alcohol abuse is a cause for dilated cardiomyopathy in turn cardiomegaly [3]
Genetic and inherited conditions [8] Glycogen storage disease is one such inherited condition which cause cardiomegaly as well as there's a familial form as well.[8]
Long standing anemia [1] Anemia causes heart failure by increased work load on the heart [1]
Amyloidosis [9] Amyloid can accumulate in tissues and organs including the heart and there's increased thickness of the cardiac muscle observed [9]
Hemochromatosis [10] This is an autosomal recessive disorder which is seen mainly in patients dependent on transfusion of blood such as Thalassemia and iron deposition in the heart can cause cardiomegaly [10]
Giant left atrium [6] This is a rare cause of cardiomegaly which causes enlargement of the left atrium and resultant cardiomegaly [6]
References
  1. HEGDE N, RICH MW, GAYOMALI C. The Cardiomyopathy of Iron Deficiency Tex Heart Inst J [online] 2006, 33(3):340-344 [viewed 07 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592266
  2. RAPSOMANIKI E, TIMMIS A, GEORGE J, PUJADES-RODRIGUEZ M, SHAH AD, DENAXAS S, WHITE IR, CAULFIELD MJ, DEANFIELD JE, SMEETH L, WILLIAMS B, HINGORANI A, HEMINGWAY H. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1?25 million people Lancet [online] , 383(9932):1899-1911 [viewed 07 July 2014] Available from: doi:10.1016/S0140-6736(14)60685-1
  3. FRANCONE M. Role of Cardiac Magnetic Resonance in the Evaluation of Dilated Cardiomyopathy: Diagnostic Contribution and Prognostic Significance ISRN Radiol [online] :365404 [viewed 07 July 2014] Available from: doi:10.1155/2014/365404
  4. MAZEREEUW G, HERRMANN N, XU H, FIGEYS D, OH PI, AL BENNETT S, LANCTôT KL. Platelet-activating factors are associated with cognitive deficits in depressed coronary artery disease patients: a hypothesis-generating study. J Neuroinflammation [online] 2014 Jul 4, 11(1):119 [viewed 07 July 2014] Available from: doi:10.1186/1742-2094-11-119
  5. RAMARAJ R., SORRELL V. L.. Peripartum cardiomyopathy: Causes, diagnosis, and treatment. Cleveland Clinic Journal of Medicine [online] December, 76(5):289-296 [viewed 07 July 2014] Available from: doi:10.3949/ccjm.76a.08004
  6. SHAH B. N., RUBENS M.. Giant left atrium: a forgotten cause of cardiomegaly. Postgraduate Medical Journal [online] December, 88(1045):673-674 [viewed 07 July 2014] Available from: doi:10.1136/postgradmedj-2012-131030
  7. PELLERIN D, BRECKER S, VEYRAT C. Degenerative mitral valve disease with emphasis on mitral valve prolapse. Heart [online] 2002 November, 88(Supplement 4):20iv-28 [viewed 07 July 2014] Available from: doi:10.1136/heart.88.suppl_4.iv20
  8. SHETH J. J., ANKLESHWARIA C. M., MISTRI M. A., NANAVATY N., MEHTA S. J.. Splenomegaly, Cardiomegaly, and Osteoporosis in a Child with Gaucher Disease. Case Reports in Pediatrics [online] 2011 December, 2011:1-4 [viewed 07 July 2014] Available from: doi:10.1155/2011/564868
  9. QUARTA C. C., KRUGER J. L., FALK R. H.. Cardiac Amyloidosis. Circulation [online] December, 126(12):e178-e182 [viewed 07 July 2014] Available from: doi:10.1161/​CIRCULATIONAHA.111.069195
  10. AJIOKA R. S.. Clinical consequences of iron overload in hemochromatosis homozygotes. [online] 2003 May, 101(9):3351-3353 [viewed 07 July 2014] Available from: doi:10.1182/blood-2002-11-3453

Investigations - for Diagnosis

Fact Explanation
Chest X-ray [1] The heart is considered enlarged if the cardiothoracic ratio is greater than 50% on a Postero-anterior view. Other signs of heart failure such as pulmonary oedema, septal (Kerley B) lines, and pleural effusions can also be present [1]
Electrocardiogram [2] Features of left ventricular hypertrophy can be observed and they are increased R wave amplitude in the left-sided ECG leads (I, aVL and V4-6) , increased S wave depth in the right-sided leads (III, aVR, V1-3). Features of right ventricular hypertrophy are Right axis deviation , tall R-waves in Right ventricular leads, deep S-waves in left ventricular leads. Additionally atrial and ventricular arrhythmias may be present [2]
Echocardiogram [3] This test helps in the assessment of left ventricular size, chamber diameters, mass and function in the form of ejection fraction. It also helps to exclude valvular diseases and other causes [3]
Exercise Electrocardiogram [4] As ischemic heart disease due to coronary artery disease is a common cause for cardiomegaly, this test may help in determining the cardiac function in exertion [4]
Coronary angiogram [5] As ischemic heart disease due to coronary artery disease is a common cause for cardiomegaly, this test may help in determining the patency of coronary arteries [5]
Cardiac MRI [6] Ejection fraction and regional wall motion can be assessed. [6]
Full blood count [7] To exclude anemia causing high output cardiac failure [7]
Serum iron studies [7] [8] To exclude anemia causing high output cardiac failure and also to exclude haemachromatosis [7] [8]
Serum cholesterol level [9] As atherosclerosis contributes to coronary artery disease, this will be helpful in determining the serum cholesterol levels. [9]
B-type natriuretic peptide [10] levels increase with ventricular wall stretch and help in the diagnosis of heart failure [10]
References
  1. PUDDY E., HILL C.. Interpretation of the chest radiograph. Continuing Education in Anaesthesia, Critical Care & Pain [online] 2007 May, 7(3):71-75 [viewed 07 July 2014] Available from: doi:10.1093/bjaceaccp/mkm014
  2. BUCHNER STEFAN, DEBL KURT, HAIMERL JOSEF, DJAVIDANI BEHRUS, POSCHENRIEDER FLORIAN, FEUERBACH STEFAN, RIEGGER GUENTER AJ, LUCHNER ANDREAS. Electrocardiographic diagnosis of left ventricular hypertrophy in aortic valve disease: evaluation of ECG criteria by cardiovascular magnetic resonance. Array [online] 2009 December [viewed 07 July 2014] Available from: doi:10.1186/1532-429X-11-18
  3. SUNDSTROM J., LIND L., ARNLOV J., ZETHELIUS B., ANDREN B., LITHELL H. O.. Echocardiographic and Electrocardiographic Diagnoses of Left Ventricular Hypertrophy Predict Mortality Independently of Each Other in a Population of Elderly Men. Circulation [online] 2001 May, 103(19):2346-2351 [viewed 07 July 2014] Available from: doi:10.1161/​01.CIR.103.19.2346
  4. SIMOONS M. L., HUGENHOLTZ P. G.. Gradual changes of ECG waveform during and after exercise in normal subjects. Circulation [online] 1975 October, 52(4):570-577 [viewed 07 July 2014] Available from: doi:10.1161/​01.CIR.52.4.570
  5. SCANLON P. J., etal. ACC/AHA Guidelines for Coronary Angiography: Executive Summary and Recommendations : A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) Developed in collaboration with the Society for Cardiac Angiography and Interventions. Circulation [online] 1999 May, 99(17):2345-2357 [viewed 07 July 2014] Available from: doi:10.1161/​01.CIR.99.17.2345
  6. CHINALI M., AURIGEMMA G. P.. Refining Patterns of Left Ventricular Hypertrophy Using Cardiac MRI: "Brother, Can You Spare a Paradigm?". Circulation: Cardiovascular Imaging [online] December, 3(2):129-131 [viewed 07 July 2014] Available from: doi:10.1161/​CIRCIMAGING.110.944959
  7. GODDARD A F. Guidelines for the management of iron deficiency anaemia. [online] 2000 June, 46(90004):1iv-5 [viewed 07 July 2014] Available from: doi:10.1136/gut.46.suppl_4.iv1
  8. LIMDI J.K., CRAMPTON J.R.. Hereditary haemochromatosis. QJM [online] December, 97(6):315-324 [viewed 07 July 2014] Available from: doi:10.1093/qjmed/hch065
  9. RAVNSKOV U.. Is atherosclerosis caused by high cholesterol?. [online] 2002 June, 95(6):397-403 [viewed 07 July 2014] Available from: doi:10.1093/qjmed/95.6.397
  10. MAISEL A.. B-Type Natriuretic Peptide Levels: Diagnostic and Prognostic in Congestive Heart Failure: What's Next?. [online] 2002 May, 105(20):2328-2331 [viewed 07 July 2014] Available from: doi:10.1161/​01.CIR.0000019121.91548.C2

Investigations - Fitness for Management

Fact Explanation
Full blood count [3] This is done to exclude significant anaemia [3]
Serum Creatinine and Blood urea nitrogen, and serum electrolytes [3] Patients with heart failure are on long term diuretics and diuretics are notorious to cause electrolyte abnormalities such as hpokalemia, hyponatremia, and sometimes uremia. Hypokalemia is also found in cardiac surgical patients. This test is also done to assess renal function before anesthesia [3]
Coagulation profile [3] To exclude any coagulopathy, and also specially since patients are on Warfarin this is important [3]
Echocardiography [1] [2] To evaluate the ejection fraction, and valvular regurgitation prior to cardiac surgery [1] [2]
Cardio-pulmonary exercise testing [1] [2] To evaluate the cardiac function before cardiac surgery [1] [2]
References
  1. SCHWAIBLMAIR MARTIN, REICHENSPURNER HERMANN, MÜLLER CHRISTIAN, BRIEGEL JOSEF, FÜRST HEINER, GROH JÜRGEN, REICHART BRUNO, VOGELMEIER CLAUS. Cardiopulmonary Exercise Testing Before and After Lung and Heart–Lung Transplantation. Am J Respir Crit Care Med [online] 1999 April, 159(4):1277-1283 [viewed 07 July 2014] Available from: doi:10.1164/ajrccm.159.4.980511
  2. STRUTHERS R., ERASMUS P., HOLMES K., WARMAN P., COLLINGWOOD A., SNEYD J. R.. Assessing fitness for surgery: a comparison of questionnaire, incremental shuttle walk, and cardiopulmonary exercise testing in general surgical patients. British Journal of Anaesthesia [online] December, 101(6):774-780 [viewed 07 July 2014] Available from: doi:10.1093/bja/aen310
  3. CORNELISSEN H.. Preoperative assessment for cardiac surgery. Continuing Education in Anaesthesia, Critical Care & Pain [online] 2006 June, 6(3):109-113 [viewed 07 July 2014] Available from: doi:10.1093/bjaceaccp/mkl013

Investigations - Followup

Fact Explanation
full blood count [1] In patient serial full blood counts are done to detect anaemia if it's the cause, and response to treatment [1]
Echocardiography [2] Serial echocardiographic investigations are done to evaluate ejection fraction, diastolic dysfunction and response to treatment. [2]
Serum electrolytes [3] Since patients are put on diuretics for congestive cardiac failure and angiotensinogen converting enzyme inhibitors it's important to monitor serum electrolytes [3]
Prothrombin time and international normalization ratio [4] As patients are put on Warfarin to combat thrombo-embolism especially in dilated cardiomyopathy it's important to monitor this [4]
Serum cholesterol level [5] As atherosclerosis is a main contributory factor for coronary artery disease and subsequent cardiomegaly, serum cholesterol levels are done in follow up [5]
References
  1. GODDARD A F. Guidelines for the management of iron deficiency anaemia. [online] 2000 June, 46(90004):1iv-5 [viewed 07 July 2014] Available from: doi:10.1136/gut.46.suppl_4.iv1
  2. SUNDSTROM J., LIND L., ARNLOV J., ZETHELIUS B., ANDREN B., LITHELL H. O.. Echocardiographic and Electrocardiographic Diagnoses of Left Ventricular Hypertrophy Predict Mortality Independently of Each Other in a Population of Elderly Men. Circulation [online] 2001 May, 103(19):2346-2351 [viewed 07 July 2014] Available from: doi:10.1161/​01.CIR.103.19.2346
  3. Part 10.1: Life-Threatening Electrolyte Abnormalities. Circulation [online] 2005 November, 112(24_suppl):IV-121-IV-125 [viewed 07 July 2014] Available from: doi:10.1161/CIRCULATIONAHA.105.166563
  4. FIUMARA K., GOLDHABER S. Z.. A Patient's Guide to Taking Coumadin/Warfarin. Circulation [online] 2009 March, 119(8):e220-e222 [viewed 07 July 2014] Available from: doi:10.1161/CIRCULATIONAHA.108.803957
  5. RAVNSKOV U.. Is atherosclerosis caused by high cholesterol?. [online] 2002 June, 95(6):397-403 [viewed 07 July 2014] Available from: doi:10.1093/qjmed/95.6.397

Investigations - Screening/Staging

Fact Explanation
Genetic testing for dilated cardiomyopathy [1] This is done in patients who have a family history of dilated cardiomyopathy and the presence for specific genes are tested and more than 10 genes have been identified. [1]
Genetic testing for hypertrophic obstructive cardiomyopathy [2] There's a familial form inherited as autosomal dominant inheritance [2]
References
  1. KU L.. Familial Dilated Cardiomyopathy. Circulation [online] 2003 October, 108(17):118e-121 [viewed 07 July 2014] Available from: doi:10.1161/​01.CIR.0000097493.70422.50
  2. MARON B. J.. Hypertrophic Cardiomyopathy. [online] 2002 November, 106(19):2419-2421 [viewed 07 July 2014] Available from: doi:10.1161/​01.CIR.0000034170.83171.0B

Management - General Measures

Fact Explanation
Patient education [1] [2] [3] Patient should be educated on the aetiology of the disease, the course, importance of follow up, the advices regarding Warfarin and other medication, diet and exercise, and to cut down drinking if it's dilated cardiomyopathy due to alcohol [1]
Diet [2] [3] Special restrictions in the diet is unnecessary except for low salt diet and in congestive cardiac failure and low cholesterol if patient is having atherosclerosis [2]
Exercise [2] [3] Moderate endurance aerobic activities are recommended but strenuous activities are better avoided [2]
References
  1. FIUMARA K., GOLDHABER S. Z.. A Patient's Guide to Taking Coumadin/Warfarin. Circulation [online] 2009 March, 119(8):e220-e222 [viewed 07 July 2014] Available from: doi:10.1161/CIRCULATIONAHA.108.803957
  2. MOSER D. K.. Improving Outcomes in Heart Failure: It's Not Unusual Beyond Usual Care. [online] 2002 June, 105(24):2810-2812 [viewed 07 July 2014] Available from: doi:10.1161/01.CIR.0000021745.45349.BB
  3. JEON YUN-HEE, KRAUS STEFAN G, JOWSEY TANISHA, GLASGOW NICHOLAS J. The experience of living with chronic heart failure: a narrative review of qualitative studies. Array [online] 2010 December [viewed 07 July 2014] Available from: doi:10.1186/1472-6963-10-77

Management - Specific Treatments

Fact Explanation
Management of heart failure with pharmacological therapy [1] [2] [5] Patients are put on heart failure regime once the heart failure ensues. Diuretics, Digoxin, After-load reduction with angiotensinogen converting enzyme inhibitors are used [1]
Anticoagulant therapy [3] Anticoagulant therapy is started with Warfarin to combat thrombo-embolism due to dilated cardiomyopathy, valvular heart disease. [3]
Pharmacological therapy with anti-hypertensives [4] If the cause is long standing hypertension, treatment can be started with antihypertensives such as angiotensinogen converting enzyme inhibitors, beta blockers, calcium channel blockers, or thiazide diuretics and these drugs are used according to guidelines [4]
Cardiac Resynchronization Therapy [6] When medical therapy fails this is one option. As patients tend to have arrhythmias, implantable cardioverter defibrillators are used. The patient selection criteria are QRS complex duration >120 to 130 ms, heart failure with NYHA class III or IV symptoms, and optimal medical treatment for heart failure, including β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and diuretics. [6]
Valve repair/ replacement [7] If the cause of the cardiomegaly is valvular heart disease, the affected valve can be surgically repaired or replaced. [7]
Ventricular assist device [8] It does the action of the heart by pumping blood and this is a treatment option for patients awaiting heart transplant [8]
Heart Transplant [9] The final treatment option for cardiomegaly is a heart transplant. [9]
References
  1. GILLESPIE N. D. The diagnosis and management of chronic heart failure in the older patient. British Medical Bulletin [online] 2006 February, 75-76(1):49-62 [viewed 07 July 2014] Available from: doi:10.1093/bmb/ldh060
  2. AHMED A. DEFEAT - Heart Failure: A Guide to Management of Geriatric Heart Failure by Generalist Physicians Minerva Med [online] 2009 Feb, 100(1):39-50 [viewed 07 July 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2914573
  3. FIUMARA K., GOLDHABER S. Z.. A Patient's Guide to Taking Coumadin/Warfarin. Circulation [online] 2009 March, 119(8):e220-e222 [viewed 07 July 2014] Available from: doi:10.1161/CIRCULATIONAHA.108.803957
  4. GU Q., BURT V. L., DILLON C. F., YOON S.. Trends in Antihypertensive Medication Use and Blood Pressure Control Among United States Adults With Hypertension: The National Health and Nutrition Examination Survey, 2001 to 2010. Circulation [online] December, 126(17):2105-2114 [viewed 07 July 2014] Available from: doi:10.1161/​CIRCULATIONAHA.112.096156
  5. TAYLOR S. H.. Congestive heart failure: Towards a comprehensive treatment. European Heart Journal [online] 1996 April, 17(suppl B):43-56 [viewed 07 July 2014] Available from: doi:10.1093/eurheartj/17.suppl_B.43
  6. STRICKBERGER S. A.. Patient Selection for Cardiac Resynchronization Therapy: From the Council on Clinical Cardiology Subcommittee on Electrocardiography and Arrhythmias and the Quality of Care and Outcomes Research Interdisciplinary Working Group, in Collaboration With the Heart Rhythm Society. Circulation [online] 2005 April, 111(16):2146-2150 [viewed 07 July 2014] Available from: doi:10.1161/​01.CIR.0000161276.09685.4A
  7. FEDAK P. W.M., MCCARTHY P. M., BONOW R. O.. Evolving Concepts and Technologies in Mitral Valve Repair. Circulation [online] 2008 February, 117(7):963-974 [viewed 07 July 2014] Available from: doi:10.1161/​CIRCULATIONAHA.107.702035
  8. GIVERTZ M. M.. Ventricular Assist Devices: Important Information for Patients and Families. Circulation [online] December, 124(12):e305-e311 [viewed 07 July 2014] Available from: doi:10.1161/​CIRCULATIONAHA.111.018226
  9. JURT U.. Heart Transplant: What to Expect. [online] 2002 October, 106(14):1750-1752 [viewed 07 July 2014] Available from: doi:10.1161/​01.CIR.0000031169.85931.4D