Heart failure for syndicate By M.Wafaie Aboleineen,MD,FACC ESC Guidelines for the diagnosis and treatment of heart failure Part I 1
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Common ECG abnormalities in HF 3
Common CXR abnormalities in HF Common Lab. Findings in HF 4
Lab. Common Echocardiographic abnormalities in heart failure 5
Part II 1- ESC Guidelines for the diagnosis and treatment of heart failure Additional Investigations Highly accurate, versatile and specific investigation to determine LV and RV volumes, functions, Regional Wall motions, myocardial thickening and thickness, masses, tumors, pericardial diseases, congenital heart defects Use of gadolinium to asses inflammation, infiltration and scaring in myocardial infarction, myocarditis, pericarditis, cardiomyopathy, storage diseases. 6
VI- Management A) Non-Pharmacological B) Pharmacological Non-Pharmacological Essential topics in patient education with associated skills and appropriate self-care behaviours 7
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Digoxin 1. Symptomatic HF and AF, digoxin may be used to slow a rapid ventricular rate. In patients with AF and an LVEF<40% it should be used to control heart rate in addition to, or prior to a b-blocker. ( I,C) 2. Symptomatic HF and an LVEF < 40% if in sinus rhythm, digoxin (in addition to an ACEI) improves ventricular function and patient wellbeing, reduces hospital admission for worsening HF, but has no effect on survival. (IIa, B). 3. While digoxin alone may control the ventricular rate at rest (target =80 b.p.m.), it does not usually provide sufficient rate control during exercise (target heart rate 110 120 b.p.m.) 4. Digoxin did not alter all-cause mortality but did lead to an RRR for hospital admission for worsening HF of 28% within an average of 3 years of starting treatment. 5. Digoxin can cause atrial and ventricular arrhythmias, particularly in the context of hypokalaemia, and serial monitoring of serum electrolytes and renal function is mandatory. 11
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ESC Guidelines for the diagnosis and treatment of heart failure Part III 13
Acute heart failure 14
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Non-invasive ventilation Non-invasive ventilation (NIV) refers to all modalities that assist ventilation without the use of an endotracheal tube but rather with a sealed face-mask. NIV with positive end-expiratory pressure (PEEP) should be considered as early as possible in every patient with acute cardiogenic pulmonary oedema and hypertensive AHF as it improves clinical parameters including respiratory distress. NIV with PEEP improves LV function by reducing LV afterload. Should be used with caution in cardiogenic shock and right ventricular failure. (IIa, level of evidence B). Intubation and mechanical ventilation should be restricted to patients in whom oxygen delivery is not adequate by oxygen mask or NIV, and in patients with increasing respiratory failure or exhaustion as assessed by hypercapnia. 16
Part Iv ESC Guidelines for the diagnosis and treatment of heart failure HEART FAILURE IN SPECIAL SITUATIONS 17
Diabetes mellitus (DM) 1. DM is a major risk factor for the development of cardiovascular disease and HF. 2. ACEIs and ARBs can be useful in patients with DM to decrease the risk of end-organ damage and cardiovascular complications and subsequently risk of HF. (IIa, A for ACEI and C for ARB). 3. DM is a frequent co-morbidity in HF, affecting 20 30% of patients. 4. DM may have a deleterious impact on the natural course of HF particularly in those with ischaemic cardiomyopathy. 18
Renal dysfunction is common in HF, and the prevalence increases with HF severity, age, a history of hypertension, or DM. In HF, renal dysfunction is strongly linked to increased morbidity and mortality. Cause of renal dysfunction should be sought in order to detect potentially reversible causes such as hypotension, dehydration, Use of ACEIs, ARBs, or other concomitant medications (e.g. NSAIDs), and renal artery stenosis. 19