Cardiac Resynchronisation Therapy
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This document summarizes the results of the CARE-HF trial, which investigated the effects of cardiac resynchronization therapy (CRT) in patients with heart failure. The trial found that CRT significantly reduced the risks of death and hospitalization compared to medical therapy alone. For every 9 patients treated with CRT, 1 death and 3 hospitalizations were prevented. The results provide strong evidence that CRT can reduce both morbidity and mortality in patients with moderate to severe heart failure.
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The EMPHASIS-HF trial studied the effects of adding eplerenone to recommended medical therapy in patients with systolic heart failure and mild symptoms. The trial found that adding eplerenone reduced the primary composite outcome of cardiovascular death or heart failure hospitalization by 37% compared to placebo. Eplerenone also reduced mortality from any cause by 24% and hospitalization from any cause by 23%. The benefits were consistent across subgroups. Safety analysis found eplerenone increased serum potassium similarly to other trials. The study concluded that addition of eplerenone to recommended medical therapy reduces morbidity and mortality for patients with mild systolic heart failure.
Acute Decompensated Heart Failure
Low dose dopamine increases GFR and RBF. The DAD-HF trial investigated 60 patients randomized to low dose furosemide (continuous infusion 0.5 mg/kg/day) with or without low dose dopamine (2 μg/kg/min). Dopamine preserved renal function compared to furosemide alone in patients with acute decompensated heart failure. There were no significant differences found in a trial comparing high vs low dose furosemide or bolus vs continuous infusion on renal function or symptoms. Novel agents targeting fluid overload, renal function, contractility, and vasomotion may provide new therapeutic options for acute heart failure.
Acute Decompensated Heart Failure CSI13
Prof. U. C. SAMAL provides an overview of acute decompensated heart failure and what is new in the field. He discusses similarities and differences between acute myocardial infarction and acute heart failure syndromes. Mortality rates are high for both conditions, though clinical benefits of interventions are greater for acute MI based on published clinical trials. The document then discusses definitions and classifications of acute heart failure syndromes, as well as guidelines for diagnosis and treatment from ESC and ACC/AHA. Biomarkers that can help with diagnosis, prognosis, and guiding therapy are also summarized.
Guidelines and beyond new drug therapy for heart failure with reduced ejectio...
This document provides information on new guidelines and therapies for heart failure patients. It begins by outlining the challenges of managing heart failure patients and their high mortality rates. It then discusses the history of heart failure treatments from ACE inhibitors in the 1990s to newer drugs like ARNi's. The document defines the different types of heart failure - HFrEF, HFmrEF, and HFpEF - and their diagnostic criteria. It explains how neprilysin inhibition enhances natriuretic peptides while simultaneously suppressing the RAAS. Finally, it summarizes that the new drug LCZ696 combines neprilysin inhibition with an ARB to reduce mortality and hospitalization in heart failure patients beyond existing neurohormonal therapies
G Lipid Lowering In Ckd
- The document discusses the evidence for lipid lowering therapy in patients with chronic kidney disease (CKD). It summarizes data from major trials showing proportional reductions in major vascular events with reductions in LDL cholesterol.
- For patients at high risk of atherosclerotic events like those with diabetes or known heart disease, statin therapy may provide similar benefits regardless of kidney function, though the evidence is less clear for patients on dialysis or with mild CKD.
- Ongoing trials like SHARP and AURORA aim to provide more evidence on the risks and benefits of statin therapy in patients with CKD or on dialysis.
Clinical management of crt non responders
1. While CRT is effective for many patients, approximately one-third do not experience full benefits. Non-response can be due to factors like suboptimal device settings, medical therapy, or lead placement.
2. Managing CRT patients involves optimizing medical treatment, monitoring the device, educating patients, and regular follow-ups. Device settings like AV/VV timing and using multi-site pacing can improve outcomes.
3. For non-responders, following a protocol to re-evaluate device settings, medical compliance, and consider lead repositioning or additional optimization may increase the likelihood of a positive response.
Cardiac resynchronization
This document discusses the history and evidence for cardiac resynchronization therapy (CRT). It notes that approximately 25% of heart failure patients have intraventricular conduction delays that cause dyssynchronous contraction. CRT aims to resynchronize contraction by pacing both ventricles simultaneously. Randomized controlled trials found CRT improves symptoms, exercise capacity, and survival in patients with low ejection fraction and wide QRS. Guidelines recommend CRT for class III/IV heart failure patients with LBBB morphology and QRS >120ms. Some evidence also supports benefit in milder heart failure. Response can vary and not all patients respond equally.
Devices
Modern devices such as implantable defibrillators (ICDs) and cardiac resynchronization therapy (CRT) are playing an expanding role in treating heart failure. CRT aims to improve synchronization of ventricular contractions in patients with left bundle branch block and a widened QRS complex. It has been shown to improve symptoms, exercise capacity, and reduce hospitalizations and mortality in moderate to severe heart failure patients. ICDs provide protection against sudden cardiac death from arrhythmias in patients with reduced left ventricular ejection fraction. Guidelines recommend considering CRT for appropriate candidates with LVEF <35% and QRS >120ms and considering ICDs for those with LVEF <35% who are not in NYHA
Risk stratification to prevent SCD in young athletes
Risk stratification to prevent SCD in young athletes presentation by Prof.Khaled Hussein, Critical Care Center, Cairo University
Atrial fibrillation in advanced heart failure role of rate control
1) Treating atrial fibrillation in patients with advanced heart failure remains a challenge due to the risks of both rate and rhythm control strategies.
2) Rate control is preferred over rhythm control, though strict heart rate targets may not be necessary, and beta blockers provide less clear benefit for rate control in AF patients with heart failure compared to those in sinus rhythm.
3) Antiarrhythmic drugs for rhythm control have been shown to increase risks of death and hospitalization, so non-pharmacological approaches and newer agents are being explored.
Sudden cardiac death
This document provides information on sudden cardiac death (SCD), including its definition, epidemiology, risk factors, etiologies, and prevention. Some key points:
- SCD is defined as a natural death from cardiac causes within 1 hour of symptoms. It is a major cause of mortality, accounting for 10-15% of natural deaths.
- Risk factors include prior heart disease, low ejection fraction, family history, and cardiomyopathy. The risk is bimodal with peaks under 1 year old and over 65 years old.
- Causes include ventricular arrhythmias, asystole, and pulseless electrical activity. Prevention strategies include implantable defibrillators, antiarrhythmic drugs
Optimizing heart failure management
Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICDs) can help optimize heart failure management. CRT improves symptoms, reduces hospitalizations, and increases survival in patients with reduced ejection fraction, left bundle branch block, and wide QRS duration. ICDs prevent sudden cardiac death in high-risk patients with prior heart failure, low ejection fraction, or history of dangerous arrhythmias. New devices use adaptive and multi-point pacing to better resynchronize the left ventricle. Device therapy improves outcomes when guided by clinical evidence and used in appropriate heart failure patients.
Chf
The document discusses congestive heart failure (CHF), including its definition, epidemiology, pathophysiology, diagnosis, classification, and treatment approaches. It notes that CHF affects over 5 million Americans and costs over $10 billion annually. The main causes are coronary artery disease and hypertension. Treatment focuses on reducing preload and afterload through ACE inhibitors, beta-blockers, and aldosterone antagonists. Other therapies include diuretics, digoxin, resynchronization devices, and ventricular assist devices.
ueda2011 hypertensive diabetic patient-d.adel
This document discusses the rational for using the combination of amlodipine and valsartan to treat hypertensive diabetic patients. It notes that hypertension is present in 20-60% of diabetic patients and substantially increases their risk of complications. While guidelines recommend tight control of both blood pressure and blood glucose, many patients require multiple medications to achieve targets. The combination of amlodipine, a calcium channel blocker, and valsartan, an angiotensin receptor blocker, provides complementary mechanisms of action that allow for more effective blood pressure control with fewer side effects compared to monotherapies. Clinical trials demonstrate the amlodipine/valsartan combination is well-tolerated and effective at reducing blood pressure
HF Essentials-PD- Case based discussion_Cardio.CP.Nephro.pptx
Based on the information provided:
1. Kartik has HFrEF with an LVEF of 34% and is on guideline directed medical therapy including ACEi/ARB and beta-blocker.
2. However, he continues to have mild symptoms of fatigue and shortness of breath with elevated NT-proBNP and worsening renal function.
3. Mortality remains high in HFrEF patients despite standard therapies. A new class of drug that provides greater reduction in mortality is needed.
The next appropriate step would be to add sacubitril/valsartan (ARB/neprilysin inhibitor) to his medical regimen to further reduce the risk of mortality based on its proven
Cardiac resynctmh
This document summarizes information on device therapy for congestive heart failure, including cardiac resynchronization therapy (CRT). It discusses:
1) The prevalence and mortality rates of heart failure in the US. Up to 30% of CHF patients have intraventricular conduction delays which increase mortality.
2) NYHA heart failure classifications and guidelines for CRT approval for classes III and IV.
3) Clinical trials that demonstrated the benefits of CRT including increased exercise capacity, quality of life, and decreased hospitalizations and mortality.
4) Anatomical challenges of CRT implantation via the coronary sinus and risks of the procedure. Proper lead placement is important to reduce asynchrony.
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- 2. The Effect of Cardiac Resynchronization on Morbidity and Mortality in Heart Failure (CARE-HF) John G.F. Cleland, M.D., Jean-Claude Daubert, M.D., Erland Erdmann, M.D., Nick Freemantle, Ph.D., Daniel Gras, M.D., Lukas Kappenberger, M.D. and Luigi Tavazzi, M.D. N Engl J Med Volume 352;15:1539-1549 April 14, 2005
- 6. Baseline Characteristics of the Patients Cleland, J. et al. N Engl J Med 2005;352:1539-1549
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