Heart FailureQuick-guide

Francisco J. Chacón-LozsánMD student UCLA-Venezuela

European Society of Cardiology: Heart Failure Association

Acute Cardiovascular Care AssociationLinkedIn: http://ve.linkedin.com/in/chaconlozsanfrancisco

2013

DEFINITION

Heart Failure (HF) Is a clinic condition which

the cardiac output in not adequate to supply

the tissue needs.

DIAGNOSIS CRITERIAFramingham

Major Criteria Minor Criteria Major and minor criteria

•Orthopnea or nocturnal paroxysmal dyspnea.•Neck veins distension.•Crackles.•Cardiomegaly.•Acute pulmonary edema.•3°Cardiac murmur.•CVP >6cmH2O•Hepatic-Jugular reflux.

•Lower extremities bilateral edema, nocturnal cough or efforts dyspnea.•Hepatomegaly•Pulmonary vital capacity reduced 50%•HR>120/min

•Weigh loss >4,5Kg with treatment.

TO ESTABLISH THE DIAGNOSIS OF HF YOU NEED 2

MAJOR CRITERIA OR 1 MAJOR AND 2 MINOR.

STRATIFICATION

STRATIFICATION AHA functional stratification of HF

ACUTE TREATMENT

Clinic presentation Characteristics Objectives

SBP >160mmHg Pulmonary congestion without systemic congestion. Many with Ejection Fraction (EF) preserved.

Objective: Volume management. BP control. Therapy: Vasodilator and loop diuretics.

Normal BP or moderate high BP (>160mmHg).

Gradual depression associated to systemic congestion. Radiologic pulmonary congestion in patients with advanced HF.

Objective: Volume management.Therapy: Vasodilator with or without loop diuretics.

Low BP (>90mmHg) Related to low cardiac output with depression of renal function.

Objective: Cardiac output.Therapy: Cardiac inotropic with vasodilator properties, consider digoxin, vasodilators and mechanical assistance.

Cardiogenic Shock. Fast, complicated with MI, fast myocarditis, acute valvular disease.

Objective: Rise pump function.Therapy: vasoactive drugs, Inotropic and mechanical assistance.

Presentación clínica Características Objetivos

Acute pulmonary edema. Abrupt, impaired by severe hyperventilation. Patient responses fast to vasodilators and diuretics.

Objective: Volume management.Therapy: Vasodilators, diuretics, ventilation, morphine.

ACS with acute HF Many patients have sings and symptoms of HF that get better resolving ischemia.

Objectives: Thrombolysis, plaque stabilization, ischemic correction.Therapy: Reperfusion by PCI, lysis, nitrates, antipatelet agents.

Isolated Right HF IC or intrinsic RV failure or valvular disease.

Rapid of gradual, primary or secondary to HBP or RV pathology.

Objective: BP management.Therapy: Nitrates, phosphodiesterase inhibitors, endoteline inhibitors, RV MI reperfusion, valvular surgery.

HF post cardiac surgery. Can be caused by inadequate myocardial protection resulting in cardiac damage.

Objective: Volume management, rise CO.Therapy: Use diuretic or fluids, inotropic, mechanical assistance.

ACUTE TREATMENT

If still NYHA II-IV add Digoxin.

CHRONIC TREATMENT

ACE inhibitor (candesartan preferably)

+Beta-Blocker

If NYHA II-IV add MRA (spironolactone)

+Ivabradine (If using BB HR>70/min)

Still NYHA II-IV: Consider Pacemaker• If QRS > 0,12sec use resynchronization.• If QRS < 0,12sec use Automatic Implantable

Defibrillator.

¿IF HAVE ATRIAL FIBRILLATION?

¿IF HAVE ATRIAL FIBRILLATION?

¡DON’T EVER FORGET!

SOME DOSES

SOME DOSES

SOME DOSES

REFERENCES

Thanks…