Heart failure

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Heart failure

  1. 1. Heart Failure An overview
  2. 2. <ul><li>The Management of Heart Failure: </li></ul><ul><li>The Past, the Present, and the Future </li></ul><ul><li> Eugene Braunwald, MD </li></ul>Volume 1, Issue 1; May, 2008
  3. 3. OBJECTIVES <ul><li>Disease Burden </li></ul><ul><li>2.Heart Failure Therapy in the Past, Present and Future. </li></ul>
  4. 4. IS IT A PANDEMIC???
  5. 5. Number 1 Killer
  6. 6. 5.7Million Americans
  7. 7. Mortality has more than doubled since 1979
  8. 8. >65years Leading cause of hospitalization
  9. 9. 1-2% of Health Care cost $ 39.2 Billion
  10. 10. 5 years from diagnosis only 50% alive
  11. 11. The Past
  12. 12. In 1950 first edition of Harrison’s Principles of Internal Medicine D ecubitus D ietary sodium restriction D igitalis D iuretics (mercurial) Venesection and Morphine The Management of Heart Failure: The Past, the Present, and the Future Eugene Braunwald,MD Circulation: Heart Failure. 2008;1:58-62
  13. 13. In 1970 Sixth edition of Harrison’s Principles of Internal Medicine Diuretics ( Thiazide, Loop, Potassium sparing ) β-adrenergic agonist Precipitating cause The Management of Heart Failure: The Past, the Present, and the Future Eugene Braunwald,MD Circulation: Heart Failure. 2008;1:58-62
  14. 14. The Present
  15. 15. Level of Evidence LEVEL OF EVIDENCE C A
  16. 16. ACE INHIBITORS or ARB BETA BLOCKERS DIURETICS DIGOXIN SPIRONOLACTONE OPT: Optimal Pharmacologic Therapy ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult. 2001; 1-56. ADJUNCT: HYDRALAZINE and NITRATES
  17. 17. Copyright ©2008 American Heart Association Management of heart failure over the past 40 years Katz, A. M. Circ Heart Fail 2008;1:63-71
  18. 19. Biventricular pacing therapy <ul><li>INDICATIONS: </li></ul><ul><li>Sinus rhythm, QRS interval >=120 ms </li></ul><ul><li>LV systolic dysfunction LVEF (<=35%) </li></ul><ul><li>Persistent, moderate to severe HF (NYHA III) despite optimal medical therapy. </li></ul>(Strength of Evidence = A) http://www.heartfailureguideline.org 2010 Comprehensive Heart Failure Practice Guideline
  19. 20. Cardiac Resynchronization Therapy Prolongs Survival in Patients With Left Ventricular Dysfunction: A Meta-Analysis <ul><ul><ul><li>McAlister FA. JAMA. 2007;297:2502 . </li></ul></ul></ul>
  20. 21. <ul><li>Cardiac Resynchronization Therapy Prolongs Survival in Patients With Heart Failure (The CARE-HF Trial) </li></ul>Percentage of Patients Free of Death from Any Cause or Unplanned Hospitalization for Major Cardiovascular Event Percentage of Patients Free of Death from Any Cause Cleland JG et al. N Engl J Med. 2005:352;1539 .
  21. 23. ICD Therapy <ul><li>CLASS I INDICATIONS: </li></ul><ul><li>Ischemic cardiomyopathy with LVEF </li></ul><ul><li>< 35%, at least 40 days post MI, NYHA class II OR III. (Strength of Evidence = A) </li></ul><ul><li>2. Ischemic cardiomyopathy with LVEF < 30%, at least 40 days post MI, NYHA class I. (Strength of Evidence = A) </li></ul><ul><li>3. Non Ischemic cardiomyopathy with LVEF ≤ 35%, NYHA class II OR III. (Strength of Evidence = B) </li></ul>The ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities
  22. 24. Left Ventricular Assist Devices (LVAD) The Jarvik-7 The Jarvik 2000 The World's First Artificial Heart
  23. 25. Indications <ul><li>Bridge to Transplantation </li></ul><ul><li>Bridge to Recovery </li></ul><ul><li>Destination Therapy </li></ul>
  24. 26. Transcutaneous Ventricular Assist Device
  25. 27. Implantable Ventricular Assist Device
  26. 28. Ventricular Assist Device in the market HeartMate II® Arrow LionHeart DeBakey LVAD Thoratec CentriMag® Thoratec PVAD™ Thoratec IVAD™ HeartMate® XVE
  27. 29. Surgeries for heart failure
  28. 30. Coronary Revascularization
  29. 31. Valvular Surgery
  30. 32. Left Ventricular Reconstructive Surgery (Dor Procedure)
  31. 33. Batista Procedure
  32. 34. Cardiac Transplant At Groote Schuur Hospital On December 3 rd 1967
  33. 35. Mr. Louis Washkansky lived for 18 days Smithsonian‘s National Museum of American History
  34. 36. 250,000 deaths per year Only 2000 donor hearts available
  35. 37. Never make predictions
  36. 38. Genetic Mutations
  37. 39. Insertion/deletion polymorphism within the ACE gene Polymorphism of the adrenergic α 2c receptor and of the β1 adrenergic receptor
  38. 40. CELL BASED THERAPY
  39. 42. PREVENTION
  40. 43. <ul><ul><li>Thank you </li></ul></ul>

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