Intro to Heart Failure

Intro to Heart Failure

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Description: Near optimal volume status achieved or euvolemia. No heart failure complaints declines PND walk to RN station w/o DOE Near optimal medical therapy achieved /started. Transition from IV to oral and appropriate diuresis for 24 hours in hospital not squeeze and go.

HF follow up in 7 days. Received bedside education. Has a 30, any yes at least 30, day supply of meds.

 
Author: Nicholas Abbott MD  | Visits: 236 | Page Views: 477
Domain:  Medicine Category: Biology 
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Contents:
Intro to Heart Failure
NICHOLAS (NICK) ABBOTT, MD
GENERAL CARDIOLOGY FELLOW
NABBOTT@UCI.EDU

Most references are from here

Helpful site
for interns!!!


Go here!



Look like a rock star!



Well sir/mam you
know the xxx
guidelines say ***



Individualization of
care still possible
and desirable!

General Overview
 Methodology (quickly)
 Definition of heart failure (HF)
 HF classifications
 Pathophysiology (quickly)
 Initial evaluation
 Treatment
 Comorbidities… if I don’t go too slow

Methodology

General Overview
 Methodology
 Definition of heart failure (HF)
 HF classifications
 Pathophysiology (quickly)
 Epidemiology (quickly)
 Initial evaluation
 Treatment
 Fun things… if I get the time to show

Definition of HF
“Complex clinical syndrome that results from any
structural or functional impairment of ventricular
filling or ejection of blood”
Cardinal Manifestations
 Dyspnea
 Fatigue limiting exercise
 Fluid retention – pulmonary, splanchnic, peripheral

Ok but is there anything I can definitively order?

General Overview
 Methodology
 Definition of heart failure (HF)
 HF classifications
 Pathophysiology (quickly)
 Initial evaluation
 Treatment
 Fun things… If I get the time to show

HFrEF:
Systolic HF

HFpEF:
Diastolic HF
Heart
Failure

HFpEF:
Borderline

HFpEF:
Improved

Basic Ejection Fraction (EF) calculation

End Diastolic Vol – End Systolic Vol
------------------------------------------- x 100
End Diastolic Vol

But wait… what does that mean…

Types of systolic heart failure
Left sided heart failure

Clinical syndrome in which the dominant
feature is fluid congestion (primarily lung)

Right Sided heart failure

Clinical syndrome of tissue congestion: JVP,
peripheral edema, ascites, organ engorgement

Remember
Diastolic HF can happen w/o systolic HF
Systolic HF cannot happen w/o diastolic

ICM vs. NICM
Ischemic
Cardiomyopathy (ICM)

Clinically apparent that the ischemic
coronary disease is responsible for failure

Non-Ischemic
cardiomyopathy (NICM)
(systolic OR diastolic)

EVERYTHING ELSE:
Valvular Heart Disease: Severe AS, MR
Toxin mediated: Meth, EtOH, Cancer therapeutics
Tachycardia-mediated: AF, AT, AFL…
Inflammation: Myocarditis, HIV, Chagas
Infiltrative: Iron, Amyloid, Sarcoid
Other rare diseses

HFpEF
 Clinical signs of heart failure
 Evidence of preserved/normal ejection fraction EF
 Evidence of ABNORMAL LV diastolic function

Echocardiography
2. Left heart catheterization
 Diagnosis largely of EXCLUSION
1. Not all that is edema is the heart
2. Look at kidneys… (Urine Pro/Cr)
3. Look at the liver… (US abdomen, LFT/Synthetic)
4. Lymphedema can masquerade
1.

That’s fine and all but WHAT IS HFpEF!
US probe here

Diastole… since evaluating diastolic dysfunction…

Normal

E:A

>1

Abbey something… Abbeynormal..

E:A

130
5. No creatinine rise (>0.5 from baseline or for elderly >0.3
from baseline)
6. Comorbid condition controlled & treated, and pain
7. Patient verbalizes understanding of discharge
instructions and follow up care with physician/health care
providers

In Summary
HF is a complex clinical syndrome that results from
any structural or functional impairment of ventricular
filling or ejection of blood
Guideline Directed Medical Therapy Saves Lives
Patients need to be near euvolemic at time of discharge
We have a lot of amazing tings in the pipeline

General Overview
 Methodology
 Definition of heart failure (HF)
 HF classifications
 Pathophysiology (quickly)
 Initial evaluation
 Treatment
 Fun Things… if I get the chance to show

ARNI
Angiotensin Receptor and Neprolysin Inhibitor

Double Blind, Prospective, Randomized, 1:1
LVEF 70 BPM

Mild decrease in the pulse…

Even this deceased the readmissions!

Trending to significance

VAD

HVAD

SC-ICD

CRT-D