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Congestive Heart Failure
 

Congestive Heart Failure

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A power point presentation on Congestive Heart Failure, the newer concepts in diagnosis and management

A power point presentation on Congestive Heart Failure, the newer concepts in diagnosis and management

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  • Congratulations, Really nice and comprehensive presetation. Perfect for students, but even for lecturing the general physitians. I like it very much. It took you sure a lot of time to make it to such a perfection.
    Dr. Peter Olexa, PhD.
    If you dont mind, post a copy to polexa@post.sk. I would like to use some slides for my students lectures - of course with your permision and your authorship stated on it. Thaks,
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  • good one... can you mail it to me? thanks... ikhlasgirl_nurul@yahoo.com.my
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  • this is a very nice presentation plz allow me down load it.
    dr_kohif@yahoo.com
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  • this is a very nice presentation plz allow me down load it.
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  • any chance of having a copy of this presentation pls as very informative
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    Congestive Heart Failure Congestive Heart Failure Presentation Transcript

    • EKG
    • In all cases
      In selected cases
    • 32 trials (3870 ACE inhibitors & 3235 placebo)
      􀁺 The reductions in mortality from CHF were greater for men than for women, for age < 60 years than for age > 60 years, for NYHA class IV, for ejection fraction <0.25, and for CHF caused by ischemic heart disease.
      • The greatest effect was seen during the first 3 months of treatment.
      􀁺 The groups did not differ for reductions in sudden death or fatal MI
    • 123 articles 18 trials 2986 patients
      􀁺 7 (n = 562) of metoprolol, 2 (n = 1509) of carvedilol, 2 (n = 36) of nebivolol, 1 (n= 641) of bisoprolol, 1 (n = 17) of acebutolol & 1 (n = 12) of labetalol
      􀁺 Improved LVEF (P < 0.001) (11 trials)
      􀁺 Higher rates of bradycardia, hypotension, and dizziness (P < 0.001) (13 trials)
      􀁺 A decreased rate of worsening of heart failure (P < 0.001) (13 trials)
      􀁺 no difference between β-blockers placebo for maximum exercise duration (9 trials)
    • 􀁺 No difference in deaths 1181 vs 1194
      􀁺 More patients in the digoxin group were hospitalized for digoxin toxicity than in
      the placebo group (P < 0.001)
      􀁺 Subgroup analyses suggested a greater benefit among patients at high risk
      patients
      Conclusions
      􀁺 Digoxin did not affect mortality but reduced hospitalizations in patients with heart
      failure and normal sinus rhythm.
      􀁺 May need to be cautious in female where overdosing may occur
    • 􀁺 Main results
      􀁺 greater improvement in NYHA class (P < 0.001)
      􀁺 did not differ for adverse effects: 82% of patients in the spironolactone group had ≥ 1 event
      compared with 79% of patients in the placebo group (P = 0.17)
      􀁺 “serious hyperkalemia” 1% vs 2% (ns); no comment on mild-moderate
      􀁺 men in tx group had higher rate of gynecomastia or breast pain (10% vs 1%, P < 0.001).
      Conclusion
      􀁺 Spironolactone reduced all-cause mortality, death, and hospitalization from cardiac causes and
      death from CHF and improved NYHA functional class in patients with severe CHF.
    • Heart Failure & Sudden Cardiac Arrest
      Framingham Heart study – Heart Failure predicts SCD and overall mortality
      Reduced Left Ventricular Ejection Fraction & risk for sudden cardiac arrest
    • Sudden cardiac Death
      SCD-HeFT Trial
      Implantable Defibrillator
      ICD significantly reduced mortality at 4 year follow up