This refers to
cognitive dysfunction occurring in heart failure. It has been
referred to in various ways through the years. I first blogged
about it 11 years ago when it was called cardiac encephalopathy.
It has since gained increasing recognition. Here are a few key
points from a review and accompanying audio summary in JACC:
There are not only
cognitive changes but also structural changes in the brain.
It can occur in both
heart failure with reduced EF and heart failure with preserved EF.
It may be at least
partially reversible with improvement in cardiac status.
Cerebral
autoregulation may be impaired in heart failure.
Neurohumoral
activation is contributory.
TNF and other
cytokines are elevated and may contribute to cognitive dysfunction.
One third of
hospitalized patients with heart failure have been reported to have
thiamine deficiency! This may cause brain changes other than the
classic Wernicke and Korsakoff syndromes.
Depression is common
in heart failure.
What should the
clinician do?
Diagnose it via the
MMSE or some other clinical tool and exclusion of other causes.
Manage electrolyte
problems.
Optimize heart
failure management.
Identify and treat
depression.
Give thiamine???
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