Congestive Heart Failure

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

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Congestive Heart Failure

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  2. 2. EKG<br />
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  14. 14. In all cases<br />In selected cases<br />
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  20. 20. 32 trials (3870 ACE inhibitors & 3235 placebo)<br />􀁺 The reductions in mortality from CHF were greater for men than for women, for age &lt; 60 years than for age &gt; 60 years, for NYHA class IV, for ejection fraction &lt;0.25, and for CHF caused by ischemic heart disease. <br /><ul><li>The greatest effect was seen during the first 3 months of treatment.</li></ul>􀁺 The groups did not differ for reductions in sudden death or fatal MI<br />
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  23. 23. 123 articles 18 trials 2986 patients<br />􀁺 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<br />􀁺 Improved LVEF (P &lt; 0.001) (11 trials)<br />􀁺 Higher rates of bradycardia, hypotension, and dizziness (P &lt; 0.001) (13 trials)<br />􀁺 A decreased rate of worsening of heart failure (P &lt; 0.001) (13 trials)<br />􀁺 no difference between β-blockers placebo for maximum exercise duration (9 trials)<br />
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  26. 26. 􀁺 No difference in deaths 1181 vs 1194<br />􀁺 More patients in the digoxin group were hospitalized for digoxin toxicity than in<br />the placebo group (P &lt; 0.001)<br />􀁺 Subgroup analyses suggested a greater benefit among patients at high risk<br />patients<br />Conclusions<br />􀁺 Digoxin did not affect mortality but reduced hospitalizations in patients with heart<br />failure and normal sinus rhythm.<br />􀁺 May need to be cautious in female where overdosing may occur<br />
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  29. 29. 􀁺 Main results<br />􀁺 greater improvement in NYHA class (P &lt; 0.001)<br />􀁺 did not differ for adverse effects: 82% of patients in the spironolactone group had ≥ 1 event<br />compared with 79% of patients in the placebo group (P = 0.17)<br />􀁺 “serious hyperkalemia” 1% vs 2% (ns); no comment on mild-moderate<br />􀁺 men in tx group had higher rate of gynecomastia or breast pain (10% vs 1%, P &lt; 0.001).<br />Conclusion<br />􀁺 Spironolactone reduced all-cause mortality, death, and hospitalization from cardiac causes and<br />death from CHF and improved NYHA functional class in patients with severe CHF.<br />
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  37. 37. Heart Failure & Sudden Cardiac Arrest<br />Framingham Heart study – Heart Failure predicts SCD and overall mortality<br />Reduced Left Ventricular Ejection Fraction & risk for sudden cardiac arrest<br />
  38. 38. Sudden cardiac Death <br />SCD-HeFT Trial<br />Implantable Defibrillator<br />ICD significantly reduced mortality at 4 year follow up<br />

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