heart failure 2013 diagnostic procedures
DESCRIPTION
TRANSCRIPT
![Page 1: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/1.jpg)
Congestive Heart Failure
2. Diagnostic procedures
March 2013 ghennersdorf DGK ESC SES 1
Medical Science Tanzania Cardiology Lectures
Prof. Hennersdorf SES
![Page 2: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/2.jpg)
Procedures
• Clinical pathways
• Echocardiography
• Biochemistry
• Hemodynamics
• Imaging: Angiography, MRI
March 2013 ghennersdorf DGK ESC SES 2
![Page 3: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/3.jpg)
Procedures
March 2013 ghennersdorf DGK ESC SES 3
![Page 4: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/4.jpg)
General signs and symptoms
March 2013 ghennersdorf DGK ESC SES 4
![Page 5: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/5.jpg)
Definition of Heart Failure CHF
New York Heart Association (NYHA) I no visible signs and symptoms II signs and symptoms at high level exercise III signs and symptoms at low level exercise IV no physical exercise possible, bed rest
necessary
March 2013 ghennersdorf DGK ESC SES 5
Mostly used functional definition of CHF throughout the world!
![Page 6: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/6.jpg)
NYHA
March 2013 ghennersdorf DGK ESC SES 6
NYHA II NYHA III NYHA IV
NYHA I without clinical signs and symptoms
![Page 7: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/7.jpg)
Physical examination: general
• Dyspnea (rest, exercise), Orthopnea• Weight gain, swelling of the legs• Nocturia• Tachycardia (Palpitation)• Fatigue• Sweating• Nausea, vomiting, cough• Anorexia• Cachexia (cardiac)
March 2013 ghennersdorf DGK ESC SES 7
![Page 8: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/8.jpg)
Pulmonary edema/orthopnea
March 2013 ghennersdorf DGK ESC SES 8
Pulmonary edema
![Page 9: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/9.jpg)
Swelling by fluid retention
March 2013 ghennersdorf DGK ESC SES 9
Pulmonary edema
![Page 10: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/10.jpg)
Swelling by fluid retention
March 2013 ghennersdorf DGK ESC SES 10
![Page 11: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/11.jpg)
Physical examination: acute vs. chronic
• acute– Severe symptoms– No weight gain due to rapid onset– Tachycardia
• Chronic– Less severe symptoms (NYHA classes)– Weight gain– Nausea, vomiting, cough– Anorexia– Cachexia
March 2013 ghennersdorf DGK ESC SES 11
![Page 12: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/12.jpg)
Physical examination: special
• Palpation– Precordial heave– Cardiac apex localization (outside the midclavicular
line)
• Auscultation– 3rd, 4th heart sound– Mitral systolic murmur– pulmonary rales
• Prominent jugular vein (positive pulse; TI)• Hepatojugular reflux
March 2013 ghennersdorf DGK ESC SES 12
![Page 13: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/13.jpg)
Physical examination: heart sounds
March 2013 ghennersdorf DGK ESC SES 13
S4 S3OSS1 S2
Sound
ECG
![Page 14: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/14.jpg)
Physical examination: heart sounds
March 2013 ghennersdorf DGK ESC SES 14
S3S1 S2
Sound
ECG
midsystolic murmur
![Page 15: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/15.jpg)
Physical examination: functional tests
6-min walk: Pt. is forced to walk as he likes walking, standing, running etc. The achieved distance is documentedand should reach >350 (female) - 400 (male) mweak but reproducible relation to peak O2-consumption
Ergometry: objective measurement of workload, but also used for rehabilitation in special cases or postoperatively (HTX): sitting or supine, treadmill preferred
March 2013 ghennersdorf DGK ESC SES 15
![Page 16: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/16.jpg)
Physical examination: ergometry equipment
March 2013 ghennersdorf DGK ESC SES 16
Exercise device
ECG Cart
Emergency Kit (necessary)
![Page 17: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/17.jpg)
Procedures
March 2013 ghennersdorf DGK ESC SES 17
![Page 18: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/18.jpg)
Echocardiography
Underlying disease Cardiomyopathy Valve disease CHD (Stress Echo) Pathophysiology: LV filling patterns
March 2013 ghennersdorf DGK ESC SES 18
![Page 19: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/19.jpg)
Left heart failure: US LVDD*
March 2013 ghennersdorf DGK ESC SES 19
*left ventricle diast. Diameter, norm <50<mm
![Page 20: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/20.jpg)
Left heart failure: US TMF*
March 2013 ghennersdorf DGK ESC SES 20
A normal transmitral filling
B early diastolic dysfunction
C progredient diastolicDysfunction
DT deceleration time
A B
C
*Transmitral flow
![Page 21: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/21.jpg)
Left heart failure: US MI
March 2013 ghennersdorf DGK ESC SES 21
![Page 22: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/22.jpg)
Left heart failure: US TR*
March 2013 ghennersdorf DGK ESC SES 22
Eval. systolic PA pressure *Tricuspid
regurgitation
![Page 23: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/23.jpg)
Procedures
March 2013 ghennersdorf DGK ESC SES 23
![Page 24: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/24.jpg)
Chest XRay CXR
March 2013 ghennersdorf DGK ESC SES 24
normal finding
![Page 25: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/25.jpg)
Chest XR CXR
March 2013 ghennersdorf DGK ESC SES 25
Pulmonary edema
![Page 26: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/26.jpg)
Chest XR CXR
March 2013 ghennersdorf DGK ESC SES 26
Pulmonary edema after successful therapy
Pulmonary edema before therapy
![Page 27: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/27.jpg)
Angiography indications
Underlying disease (CHD) with therapeutic consequences (PCI, CABG)
Intervention (cardiogenic shock)
March 2013 ghennersdorf DGK ESC SES 27
![Page 28: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/28.jpg)
Left heart failure, hemo + angio
March 2013 ghennersdorf DGK ESC SES 28
Angio
hemodynamics
+
Left ventricle shape, size and function Pumping, blood delivery, work
![Page 29: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/29.jpg)
Left heart failure: right heart hemodynamics
March 2013 ghennersdorf DGK ESC SES 29
SWAN GANZ Catheter PA Pressure monitoring
![Page 30: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/30.jpg)
Left heart failure, hemodynamics
March 2013 ghennersdorf DGK ESC SES 30
Measurements:
Cardiac outputVentricular filling pressures, Vascular resistancesWork loadWork capacity
Limited clinical value, limited use to invasive cases (Cathlab,OP), potentially harmful!
![Page 31: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/31.jpg)
HF parameter by heart catheterization
March 2013 ghennersdorf DGK ESC SES 31
Some hemodynamic values
Cardiac output/index norm 2-2.5 l(min/m2)Stroke work norm 21 mjouleenddiastolic pressure norm 12 mm HgVascular bed resistances (norm)
TPR 1200 dyn*sec*cm-5
PVR 70 dyn*sec*cm-5
Clinical use limited to ICU controlduring vasoactive therapy e.g. of cardogenic shock
![Page 32: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/32.jpg)
CHF parameter by angiography*
March 2013 ghennersdorf DGK ESC SES 32
Ejection fraction EF
EF = ---------------EDV**
EDV**-ESV***x 100 (%)
Norm = 70%Reduced = <40%Low= <20%
Strongest predictors of survival and prognosis
*today fairly achieved by echocardiography **Enddiastolic volume/area*** endsystolic volume/area
![Page 33: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/33.jpg)
Angiography diagnose: LV shape
March 2013 ghennersdorf DGK ESC SES 33
Regional scar
Regional scar
Anterior wall infarction
Diastole
Systole
Diastole
Systole
EF < 20%red linesshow normalcontraction
Dilated cardiomyopathy
![Page 34: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/34.jpg)
Angiography diagnose: LV shape
March 2013 ghennersdorf DGK ESC SES 34
normal
Regional scar
Regional scar
Diastole
Systole
infarctionEF 70%
![Page 35: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/35.jpg)
CHF and MRI
• Dimensions• Contractility, Viability• Valve function
March 2013 ghennersdorf DGK ESC SES 35
MRI crossectionalsequence of dilated LV
![Page 36: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/36.jpg)
Procedures
March 2013 ghennersdorf DGK ESC SES 36
![Page 37: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/37.jpg)
Biochemistry
Red, white BC Blood sedimentation rate Electrolytes Urinalysis, Kreatinine Enzymes (GOT, GPT, LDH, CK, CKMB, Troponine) CRP (Inflammation) Epinephrine/Norepinephrine levels scientific Peptide (BNP/ANP) levels mostly scientific, but probably
prognostic
March 2013 ghennersdorf DGK ESC SES 37
Value: diagnostic, prognostic, therapy control
![Page 38: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/38.jpg)
Biochemistry: BNP/NT-proBNP
BNP= brain natriuretic peptide (delivered in myocardial atrial tissue during atrial stress)regulating hormone in order to reduce atrial stress
Inactive precursor of BNP = NT-proBNP Blood test after 10 min valid Mostly valid to exclude CHF under clinical conditions
March 2013 ghennersdorf DGK ESC SES 38
![Page 39: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/39.jpg)
CHF Diagnose: stepwise procedure
March 2013 ghennersdorf DGK ESC SES 39
1st step: clinical approach, additional ECG, CXR
2nd step: echocardiography
3rd step: blood tests (BNP)
4th step: exclude CHD (card-CT, Cathlab)
![Page 40: Heart failure 2013 Diagnostic Procedures](https://reader033.vdocument.in/reader033/viewer/2022061211/5492dd40b47959ab748b486b/html5/thumbnails/40.jpg)
The End
March 2013 ghennersdorf DGK ESC SES 40