Hear Failure American Heart Associatio 2017 resvision
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The following are summary points to remember about the 2017 American College of Cardiology/American Heart Association/Heart Failure Society of America (ACC/AHA/HFSA)
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A novel approach to medical management of heart failure with reduced ejection
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This document proposes a novel approach to medical management of heart failure with reduced ejection fraction (HFrEF). It discusses four medication classes - renin-angiotensin-neprilysin inhibitors, beta-blockers, mineralocorticoid antagonists, and sodium-glucose cotransporter inhibitors - which provide clear benefits to most HFrEF patients and should be prioritized as "Foundational Therapy". Additional therapies may benefit select patient subgroups and are considered "Personalized Therapy". A new "Cluster Scheme" is proposed to improve timely initiation and titration of combination medical therapy for HFrEF based on initiating all Foundational Therapies rapidly followed by titration and addressing patient-specific factors.Guideline‐Directed Medical Therapy in HFrEF
This document provides guidance on guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF). It discusses initiation and titration of therapies including angiotensin receptor-neprilysin inhibitors, beta-blockers, sacubitril-valsartan, ivabradine, SGLT2 inhibitors, ACE inhibitors, ARBs, loop diuretics, and aldosterone antagonists. Key points include initiating therapies individually based on patient status, up-titrating doses every 2 weeks to maximize benefits, assessing for response using echocardiograms and biomarkers, and continuing GDMT even if ejection fraction improves to prevent heart failure events. Transcat
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Acute Decompensated Heart Failure : What is New ?
1. The document discusses drug trials for acute decompensated heart failure and their results. Many trials tested drugs like nesiritide, milrinone, tezosentan, levosimendan, tolvaptan, and rolofylline but did not show clinical benefit.
2. It proposes classifying patients based on their clinical profile into those with volume overload, reduced cardiac output, or a combination, to help determine optimal treatment which may include diuretics, vasodilators, inotropes, or renal preservation agents.
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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.
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The document provides guidelines for evaluating and managing acute decompensated heart failure. It recommends that the diagnosis be based on signs and symptoms, and that BNP/NT-proBNP tests be used when diagnosis is uncertain. It recommends hospital admission for patients with severe symptoms such as hypotension or altered mental status. It also provides guidelines for treating patients in the hospital with diuretics, monitoring their symptoms and lab values, and considering IV medications if symptoms are not improving.
management of acute Heart failure
This document discusses acute heart failure (AHF), including its definition, initial signs of end organ dysfunction, potential end organ dysfunction, and causes. It notes that AHF often arises from a deterioration of chronic heart failure and may be a first presentation. It also discusses biomarkers like BUN and hyponatremia as predictors of outcomes. The document covers diuretic use and its association with adverse events, as well as approaches to decongestion. It defines cardiorenal syndrome in AHF and notes its association with worse outcomes. Various inotropic agents are also discussed.
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This document proposes a novel approach to medical management of heart failure with reduced ejection fraction (HFrEF). It discusses four medication classes - renin-angiotensin-neprilysin inhibitors, beta-blockers, mineralocorticoid antagonists, and sodium-glucose cotransporter inhibitors - which provide clear benefits to most HFrEF patients and should be prioritized as "Foundational Therapy". Additional therapies may benefit select patient subgroups and are considered "Personalized Therapy". A new "Cluster Scheme" is proposed to improve timely initiation and titration of combination medical therapy for HFrEF based on initiating all Foundational Therapies rapidly followed by titration and addressing patient-specific factors.Guideline‐Directed Medical Therapy in HFrEF
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1. The document discusses drug trials for acute decompensated heart failure and their results. Many trials tested drugs like nesiritide, milrinone, tezosentan, levosimendan, tolvaptan, and rolofylline but did not show clinical benefit.
2. It proposes classifying patients based on their clinical profile into those with volume overload, reduced cardiac output, or a combination, to help determine optimal treatment which may include diuretics, vasodilators, inotropes, or renal preservation agents.
3. The management of acute heart failure is divided into initial, in-hospital, and discharge phases, with goals like establishing diagnoses, treating precip
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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.
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This document discusses acute heart failure (AHF), including its definition, initial signs of end organ dysfunction, potential end organ dysfunction, and causes. It notes that AHF often arises from a deterioration of chronic heart failure and may be a first presentation. It also discusses biomarkers like BUN and hyponatremia as predictors of outcomes. The document covers diuretic use and its association with adverse events, as well as approaches to decongestion. It defines cardiorenal syndrome in AHF and notes its association with worse outcomes. Various inotropic agents are also discussed.
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PE
1) Pulmonary embolism (PE) is caused by obstruction of the pulmonary arteries by thrombi or other materials originating elsewhere in the body. PE can be massive/hemodynamically unstable or submassive/hemodynamically stable.
2) Risk factors include obesity, smoking, and hypertension. Diagnosis involves imaging tests and treatment depends on PE severity and bleeding risk.
3) For submassive PE, anticoagulation is recommended. For massive PE, thrombolysis or embolectomy may be used if not high bleeding risk. Anticoagulation duration depends on provoking factors and risk of recurrence.
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This document provides guidelines for the management of acute heart failure. It discusses current treatment strategies including diuretics, vasodilators, and inotropes. Novel therapeutic strategies are mentioned, such as newer inotropic drugs, rollofylline, tolvaptan, ularitide, relaxin, and others. The goals of therapy for acute heart failure are to make the patient feel better by reducing dyspnea, improve quality of life, reduce mortality and rehospitalization, and do so safely. Recent large clinical trials of new agents for acute heart failure have failed to show benefits observed in smaller earlier studies.
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Acei
ACEI/ARB are effective medications for treating heart failure (HF) and reducing morbidity and mortality after acute coronary syndrome (ACS). For HF, ACE inhibitors (ACEI) or angiotensin receptor blockers (ARB) are recommended to reduce HF hospitalizations and death by inhibiting the renin-angiotensin-aldosterone system. In ACS patients, ACEI reduce death from cardiovascular causes after myocardial infarction based on evidence from large randomized controlled trials. The combination of an ARB with neprilysin inhibition provides additional benefits for symptomatic HF patients beyond ACEI or ARB alone.
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This document discusses direct oral anticoagulants (DOACs) for treating and preventing blood clots. It summarizes clinical trials that found DOACs like dabigatran, rivaroxaban, apixaban, and edoxaban were as effective as warfarin for reducing strokes in atrial fibrillation with fewer bleeding risks. The document outlines the pharmacokinetics, dosing, indications and contraindications for each DOAC. It notes advantages of DOACs include rapid onset/offset, fixed dosing without monitoring, but notes disadvantages could include lack of antidotes and methods to assess patient adherence.
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The document discusses a clinical trial that evaluated the use of nesiritide in patients with acute decompensated heart failure. The trial found that nesiritide reduced pulmonary capillary wedge pressure and improved dyspnea within 3 hours compared to placebo. However, later studies raised concerns about nesiritide potentially worsening renal function and increasing mortality. While initially approved by the FDA in 2001 based on its vasodilatory effects shown in trials, the risks of nesiritide remain controversial.
Fusaro - Renal Denervation, current evidence and new technical developments
1. Renal denervation is a catheter-based procedure that uses radiofrequency energy to ablate renal nerves and lower blood pressure in patients with resistant hypertension.
2. A randomized controlled trial found that renal denervation produced significant reductions in both systolic and diastolic blood pressure compared to a control group at 6 months.
3. Potential benefits of renal denervation beyond blood pressure lowering include reduced left ventricular mass, improved glucose metabolism, and fewer episodes of atrial fibrillation. However, long-term outcomes require further study.
2009 ACCF/AHA Heart Failure Guidelines
2009 Focused Update:
ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults
J. Am. Coll. Cardiol. April 14, 2009; 53;1343-1382
Circulation. April 14, 2009;119;1977-2016
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The document discusses using BNP or NT-proBNP blood tests to screen for heart failure in primary care settings. It finds that NT-proBNP performed better than BNP in identifying patients with left ventricular systolic dysfunction. A cutoff of 150 pg/ml for NT-proBNP provided a high negative predictive value of 97.3%, avoiding unnecessary referrals while missing only one mild case of heart failure. The document proposes a study to evaluate implementing NT-proBNP screening in primary care practices to guide referrals for suspected heart failure.
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This document summarizes the PROVE-HF study which evaluated the effects of sacubitril/valsartan (ARNI) therapy on cardiac remodeling and biomarkers in patients with heart failure with reduced ejection fraction (HFrEF). The main findings were:
1) Significant reductions in NT-proBNP levels occurred within 2 weeks of starting ARNI and correlated with improvements in cardiac structure and function at 12 months including increased LVEF and reduced LV volumes.
2) Reverse cardiac remodeling occurred in all patient subgroups including those with new-onset HF, those who were ACEI/ARB naïve, and those who did not reach target ARNI doses.
3) Patients with the
Acute Heart Failure: Current Standards and Evolution of Care.2015
This document provides an overview of the current standards and evolution of care for acute heart failure (AHF). It summarizes the use of biomarkers like natriuretic peptides and troponins in the diagnosis and risk stratification of AHF. It discusses the clinical considerations in stratifying AHF patients, including systolic blood pressure, worsening renal function, and the distribution of left ventricular ejection fraction. The document reviews current treatment options for AHF such as diuretics, vasodilators like nitroglycerin, and nesiritide based on clinical trials and guidelines.
Atrial fibrillation: rate or ryhthm?
1. Rate control is the initial approach for elderly patients with minor AF symptoms, while rhythm control may be considered for symptomatic patients despite rate control.
2. Catheter ablation is recommended for symptomatic patients where medical therapy fails, and can be considered as initial therapy in some selected patients.
3. Anticoagulation is recommended for AF patients based on their stroke risk profile according to CHA2DS2-VASc score. Warfarin requires careful management during pregnancy.
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Prof. U. C. SAMAL is an expert in cardiology who has held leadership positions in several cardiological societies. The document discusses the management of acute decompensated heart failure and summarizes recent changes to guidelines. It provides an overview of pharmacological interventions for acute heart failure such as diuretics, vasodilators, and inotropes. Non-invasive ventilation and risk stratification scores are also mentioned. The document emphasizes the importance of both short-term stabilization and long-term management through multi-disciplinary programs to prevent readmissions.
Innovations in the Diagnosis and Treatment of Chronic Heart Failure
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"Heart failure is a typical clinical accompanied by symptoms syndrome (e.g. shortness of breath, ankle swelling and fatigue) that lead to structural or functional abnormalities of the heart (e.g. high venous pressure, pulmonary edema and peripheral edema).
In recent years, the significant role of B-type natriuretic peptide has been revealed in the pathogenesis of heart disease and the use of the drug sacubitril/valsartan has started. It has a positive effect on the regulation of the level of B-type natriuretic peptide in the body. It is obviously seen from the the world literature that natriuretic peptides play an important role in the pathophysiology of heart failure. For this reason, many studies suggest that the importance of natriuretic peptides in the diagnosis and treatment of heart failure is recommended.
Due to this, we tried to investigate the effects of a comprehensive medication therapy with a combination of sacubitril/valsartan in the patients with chronic heart failure."
Acute decompensated heart failure neunschwander
This document discusses acute decompensated heart failure (ADHF), which refers to new or worsening signs and symptoms of heart failure requiring medical care or hospitalization. ADHF accounts for over 50% of heart failure costs in the US. It has a high mortality and readmission rate. The document outlines common causes and presentations of ADHF and emphasizes the importance of a thorough clinical evaluation to diagnose ADHF and distinguish it from other potential causes of symptoms like shortness of breath. It describes assessing signs of congestion and hypoperfusion to classify patients and guide initial treatment.
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The document discusses guidelines for treating various hypertensive emergencies. It recommends first-line intravenous drugs like nitroprusside, fenoldopam, and labetalol. It provides guidance on treating specific complications like acute coronary syndrome, left ventricular failure, acute kidney injury, hyperadrenergic states, and acute ischemic stroke. The goal is to lower blood pressure no more than 25% initially and further gradually over 24-48 hours, avoiding excessive drops while stabilizing the patient. Exceptions are made for specific conditions like aortic dissection that require faster normalization.
Heart_Failure
- The purpose of this focused update is to revise sections of the 2013 ACCF/AHA Guideline for the Management of Heart Failure based on new evidence, including biomarkers, new therapies for HFrEF, updates on HFpEF, comorbidities, and prevention.
- Biomarkers such as BNP and NT-proBNP are useful for diagnosing and establishing prognosis in HF. New data suggest biomarker screening and early intervention may prevent HF development.
- For HFrEF Stage C/D, ARNI is now recommended to replace ACE-I or ARB to further reduce morbidity/mortality based on new trials. Concomitant use of ACE-I and ARNI may be harmful
slide-set-heart-failure-management.pptx
The document provides guidelines for the management of heart failure from the American Heart Association, American College of Cardiology, and Heart Failure Society of America. It discusses recommendations for the initial clinical assessment of patients with heart failure, including obtaining a thorough history and physical examination to evaluate symptoms, signs of advanced heart failure, family history, potential causes, and comorbidities. Regular assessment of vital signs and evidence of clinical congestion is also recommended to guide ongoing medical management.
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PE
1) Pulmonary embolism (PE) is caused by obstruction of the pulmonary arteries by thrombi or other materials originating elsewhere in the body. PE can be massive/hemodynamically unstable or submassive/hemodynamically stable.
2) Risk factors include obesity, smoking, and hypertension. Diagnosis involves imaging tests and treatment depends on PE severity and bleeding risk.
3) For submassive PE, anticoagulation is recommended. For massive PE, thrombolysis or embolectomy may be used if not high bleeding risk. Anticoagulation duration depends on provoking factors and risk of recurrence.
acute heart failure:therapeutic update
This document provides guidelines for the management of acute heart failure. It discusses current treatment strategies including diuretics, vasodilators, and inotropes. Novel therapeutic strategies are mentioned, such as newer inotropic drugs, rollofylline, tolvaptan, ularitide, relaxin, and others. The goals of therapy for acute heart failure are to make the patient feel better by reducing dyspnea, improve quality of life, reduce mortality and rehospitalization, and do so safely. Recent large clinical trials of new agents for acute heart failure have failed to show benefits observed in smaller earlier studies.
Vasopressors and inotropes in sepsis
The document discusses several studies comparing different vasopressor agents for the treatment of shock. The SOAP study found no significant difference in mortality between norepinephrine plus dobutamine versus epinephrine alone for septic shock. The CATS study also found no difference in outcomes between these two combinations. The SOAP II trial found no significant difference in mortality between dopamine and norepinephrine for shock, but dopamine was associated with more adverse events. A study by Levy et al. found that norepinephrine-dobutamine for cardiogenic shock had similar hemodynamic effects as epinephrine but with fewer metabolic side effects.
Acei
ACEI/ARB are effective medications for treating heart failure (HF) and reducing morbidity and mortality after acute coronary syndrome (ACS). For HF, ACE inhibitors (ACEI) or angiotensin receptor blockers (ARB) are recommended to reduce HF hospitalizations and death by inhibiting the renin-angiotensin-aldosterone system. In ACS patients, ACEI reduce death from cardiovascular causes after myocardial infarction based on evidence from large randomized controlled trials. The combination of an ARB with neprilysin inhibition provides additional benefits for symptomatic HF patients beyond ACEI or ARB alone.
EAHP
This document discusses direct oral anticoagulants (DOACs) for treating and preventing blood clots. It summarizes clinical trials that found DOACs like dabigatran, rivaroxaban, apixaban, and edoxaban were as effective as warfarin for reducing strokes in atrial fibrillation with fewer bleeding risks. The document outlines the pharmacokinetics, dosing, indications and contraindications for each DOAC. It notes advantages of DOACs include rapid onset/offset, fixed dosing without monitoring, but notes disadvantages could include lack of antidotes and methods to assess patient adherence.
Acute Heart Failure Syndromes
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Circulation. Nov 9, 2010;122:1975-1996
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The document discusses a clinical trial that evaluated the use of nesiritide in patients with acute decompensated heart failure. The trial found that nesiritide reduced pulmonary capillary wedge pressure and improved dyspnea within 3 hours compared to placebo. However, later studies raised concerns about nesiritide potentially worsening renal function and increasing mortality. While initially approved by the FDA in 2001 based on its vasodilatory effects shown in trials, the risks of nesiritide remain controversial.
Fusaro - Renal Denervation, current evidence and new technical developments
1. Renal denervation is a catheter-based procedure that uses radiofrequency energy to ablate renal nerves and lower blood pressure in patients with resistant hypertension.
2. A randomized controlled trial found that renal denervation produced significant reductions in both systolic and diastolic blood pressure compared to a control group at 6 months.
3. Potential benefits of renal denervation beyond blood pressure lowering include reduced left ventricular mass, improved glucose metabolism, and fewer episodes of atrial fibrillation. However, long-term outcomes require further study.
2009 ACCF/AHA Heart Failure Guidelines
2009 Focused Update:
ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults
J. Am. Coll. Cardiol. April 14, 2009; 53;1343-1382
Circulation. April 14, 2009;119;1977-2016
My stuff
The document discusses using BNP or NT-proBNP blood tests to screen for heart failure in primary care settings. It finds that NT-proBNP performed better than BNP in identifying patients with left ventricular systolic dysfunction. A cutoff of 150 pg/ml for NT-proBNP provided a high negative predictive value of 97.3%, avoiding unnecessary referrals while missing only one mild case of heart failure. The document proposes a study to evaluate implementing NT-proBNP screening in primary care practices to guide referrals for suspected heart failure.
Summary of PROVE-HF and GUIDE-IT studies by Dr. Vaibhav Yawalkar MD, DM Cardi...
This document summarizes the PROVE-HF study which evaluated the effects of sacubitril/valsartan (ARNI) therapy on cardiac remodeling and biomarkers in patients with heart failure with reduced ejection fraction (HFrEF). The main findings were:
1) Significant reductions in NT-proBNP levels occurred within 2 weeks of starting ARNI and correlated with improvements in cardiac structure and function at 12 months including increased LVEF and reduced LV volumes.
2) Reverse cardiac remodeling occurred in all patient subgroups including those with new-onset HF, those who were ACEI/ARB naïve, and those who did not reach target ARNI doses.
3) Patients with the
Acute Heart Failure: Current Standards and Evolution of Care.2015
This document provides an overview of the current standards and evolution of care for acute heart failure (AHF). It summarizes the use of biomarkers like natriuretic peptides and troponins in the diagnosis and risk stratification of AHF. It discusses the clinical considerations in stratifying AHF patients, including systolic blood pressure, worsening renal function, and the distribution of left ventricular ejection fraction. The document reviews current treatment options for AHF such as diuretics, vasodilators like nitroglycerin, and nesiritide based on clinical trials and guidelines.
Atrial fibrillation: rate or ryhthm?
1. Rate control is the initial approach for elderly patients with minor AF symptoms, while rhythm control may be considered for symptomatic patients despite rate control.
2. Catheter ablation is recommended for symptomatic patients where medical therapy fails, and can be considered as initial therapy in some selected patients.
3. Anticoagulation is recommended for AF patients based on their stroke risk profile according to CHA2DS2-VASc score. Warfarin requires careful management during pregnancy.
Losocor co training south africa Dr Saurav deka
Losacar co contain losartan and hydrochlorothiazide . This presentation give you brief about basics of hypertension and its treatment with losartan hydrochlorothiazide .
Acute Decompensated Heart Failure : What is New ?
Prof. U. C. SAMAL is an expert in cardiology who has held leadership positions in several cardiological societies. The document discusses the management of acute decompensated heart failure and summarizes recent changes to guidelines. It provides an overview of pharmacological interventions for acute heart failure such as diuretics, vasodilators, and inotropes. Non-invasive ventilation and risk stratification scores are also mentioned. The document emphasizes the importance of both short-term stabilization and long-term management through multi-disciplinary programs to prevent readmissions.
Innovations in the Diagnosis and Treatment of Chronic Heart Failure
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"Heart failure is a typical clinical accompanied by symptoms syndrome (e.g. shortness of breath, ankle swelling and fatigue) that lead to structural or functional abnormalities of the heart (e.g. high venous pressure, pulmonary edema and peripheral edema).
In recent years, the significant role of B-type natriuretic peptide has been revealed in the pathogenesis of heart disease and the use of the drug sacubitril/valsartan has started. It has a positive effect on the regulation of the level of B-type natriuretic peptide in the body. It is obviously seen from the the world literature that natriuretic peptides play an important role in the pathophysiology of heart failure. For this reason, many studies suggest that the importance of natriuretic peptides in the diagnosis and treatment of heart failure is recommended.
Due to this, we tried to investigate the effects of a comprehensive medication therapy with a combination of sacubitril/valsartan in the patients with chronic heart failure."
Acute decompensated heart failure neunschwander
This document discusses acute decompensated heart failure (ADHF), which refers to new or worsening signs and symptoms of heart failure requiring medical care or hospitalization. ADHF accounts for over 50% of heart failure costs in the US. It has a high mortality and readmission rate. The document outlines common causes and presentations of ADHF and emphasizes the importance of a thorough clinical evaluation to diagnose ADHF and distinguish it from other potential causes of symptoms like shortness of breath. It describes assessing signs of congestion and hypoperfusion to classify patients and guide initial treatment.
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- Biomarkers such as BNP and NT-proBNP are useful for diagnosing and establishing prognosis in HF. New data suggest biomarker screening and early intervention may prevent HF development.
- For HFrEF Stage C/D, ARNI is now recommended to replace ACE-I or ARB to further reduce morbidity/mortality based on new trials. Concomitant use of ACE-I and ARNI may be harmful
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Sacubitril-valsartan (angiotensin receptor-neprilysin inhibitor or ARNI) provides a novel dual approach for managing heart failure by inhibiting neprilysin to increase natriuretic peptides while blocking the renin-angiotensin-aldosterone system through angiotensin receptor blockade. The PARADIGM-HF trial found ARNI significantly reduced cardiovascular death, all-cause death, and heart failure hospitalizations compared to enalapril in patients with heart failure with reduced ejection fraction. Current guidelines recommend ARNI as a replacement for ACE inhibitors or ARBs in such patients based on the benefits demonstrated in PARADIGM-HF.
heart-failure-management- american CC guidelines
The 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure provides recommendations on the diagnosis and treatment of heart failure. Key points from the guideline include:
- New recommendations are made for treating heart failure with preserved ejection fraction (HFpEF) with sodium-glucose cotransporter-2 inhibitors, mineralocorticoid receptor antagonists, and angiotensin receptor-neprilysin inhibitors.
- Heart failure with mildly reduced ejection fraction (HFmrEF) should be treated with sodium-glucose cotransporter-2 inhibitors and other guideline-directed medical therapies.
- Amyloid heart disease has new recommendations for screening and treatment.
Cardiac Investigation In Heart Failure
This document discusses the use of B-type natriuretic peptide (BNP) testing in the evaluation of heart failure. It describes the physiology of BNP release and important caveats when interpreting BNP levels. Landmark trials are summarized that demonstrate the clinical utility of BNP for diagnosing heart failure, risk stratification of patients, and guiding heart failure management. The document recommends ordering BNP testing to help diagnose heart failure in patients with ambiguous signs and symptoms, as well as to track changes in patients' clinical status and risk over time.
2022-Heart failure ACC/AHA guidelines, comparison with ECS in the end.pptx
highlighted important points in ACC herat failure guidelines in a simple manner.Matched message from ESC guideline has been shown.
Samir rafla acute heart failure- guidelines 2017
Samir Morcos Rafla is an emeritus professor of cardiology at Alexandria University who has published guidelines on acute heart failure. Heart failure can be chronic or acute, with acute heart failure defined as a rapid onset of symptoms requiring urgent therapy. It is classified based on systolic blood pressure into normotensive, hypertensive, non-hypertensive, and hypotensive subtypes. Acute heart failure is a global public health problem associated with high rates of hospitalization and mortality.
hypertensiveemergencies-160418043048.pdf
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Hypertensive emergencies
This document defines hypertensive emergencies and discusses their management. It begins by classifying hypertension and defining hypertensive crises. Hypertensive emergencies are acute severe hypertension with signs of target organ damage, while hypertensive urgencies have severe hypertension without organ damage. The document then covers the epidemiology, etiology, pathophysiology, presentation, investigations, and management of hypertensive emergencies. It discusses treating different organ-specific emergencies like stroke, heart failure, and kidney injury. The management involves rapid blood pressure reduction while monitoring for complications. Various intravenous medications are outlined to treat specific emergencies. Careful titration is needed due to the risk of overtreatment.
Hypertension according to latest clinical advances
Hypertension is a progressive cardiovascular disorder defined as a chronic elevation of systemic arterial pressure above 140/90 mmHg. The document discusses the etiopathogenesis and pharmacotherapy of hypertension. Regarding etiology, it discusses arterial stiffness, water-sodium retention, the renin-angiotensin-aldosterone system, sympathetic dysregulation, and genetics as contributing factors. Treatment involves lifestyle modifications and pharmacotherapy including diuretics, ACE inhibitors, ARBs, calcium channel blockers, and beta-blockers. Recent advances discussed include endothelin receptor antagonists, neprilysin inhibition combined with RAAS inhibition, angiotensin II receptor agonists, SGLT2 inhibitors, and renal denervation
Guideline for the management of heart failure
This document provides guidelines for the management of heart failure. It defines heart failure and outlines the stages from A to D. It recommends obtaining a thorough history and physical exam, diagnostic tests including biomarkers, and noninvasive cardiac imaging for initial and serial evaluation of heart failure patients. Invasive hemodynamic monitoring is recommended for selected patients with acute heart failure and impaired perfusion. Invasive coronary angiography is reasonable when ischemia may be contributing to heart failure.
Cardiac Investigation In Heart Failure
This document summarizes guidelines for cardiac investigation and management of heart failure. It addresses:
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- Indications for endomyocardial biopsy and BNP testing
- Use of echocardiography and stress testing to evaluate patients
- Screening for rare diseases and comorbidities
- Use of cardiac resynchronization therapy and implantable cardioverter-defibrillators in heart failure
The document provides guidance on the appropriate use of diagnostic tests and treatments based on a patient's symptoms, ejection fraction, QRS duration, and response to medical therapy.
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.
The Problem Of Heart Failure
The document discusses heart failure, including its definition, stages, causes, symptoms, and treatment guidelines. It provides an overview of epidemiology and costs of heart failure. Guidelines from ACC/AHA classify heart failure into stages A through D based on risk or presence of symptoms. Treatment involves managing risk factors, addressing neurohormonal activation, and following medication protocols tailored to each stage.
Presentation on masked hypertension(1) 23
Masked hypertension is defined as having elevated blood pressure based on ambulatory or home monitoring, despite normal clinic or office readings. It is common in patients with chronic kidney disease, diabetes, and cardiovascular risk factors. Ambulatory blood pressure monitoring is recommended to accurately diagnose masked hypertension, as treatment based solely on office readings may miss elevated out-of-office pressures. Masked hypertension is associated with increased target organ damage and cardiovascular risk.
Hypertension+clinical
Three large international hypertension trials involving over 80,000 patients will improve understanding of hypertension management. The trials compare different drug classes and treatment strategies. They found that diuretics are as effective as newer drugs in lowering blood pressure and risk of cardiovascular events. The trials also showed tight blood pressure control, below 130/80 mmHg, provides better outcomes.
Similar to Hear Failure American Heart Associatio 2017 resvision (20)
hypertension anesthesia, general management. antihypertensive pharmacology
hypertension anesthesia, general management. antihypertensive pharmacology
2022-Heart failure ACC/AHA guidelines, comparison with ECS in the end.pptx
2022-Heart failure ACC/AHA guidelines, comparison with ECS in the end.pptx
6 HTN & CHF.pptxbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbb
6 HTN & CHF.pptxbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbbb
Hypertension according to latest clinical advances
Hypertension according to latest clinical advances
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Hear Failure American Heart Associatio 2017 resvision
- 1. Revision new guide heart failure Cesar David Ordoñez Domínguez
- 2. Introduction The scope of the focused update includes revision to the sections on biomarkers; new therapies indicated for stage C HF with reduced ejection fraction (HFrEF); updates on HF with preserved ejection fraction (HFpEF); new data on important comorbidities, including sleep apnea, anemia, and hypertension; and new insights into the prevention of HF. Update on New Pharmacological Therapy for Heart Failure”, which introduced guidance on new therapies, specifically for the use of an angiotensin receptor–neprilysin inhibitor (ARNI) (valsartan/sacubitril) and a sinoatrial node modulator (ivabradine). New data on important comorbidities, including sleep apnea, anemia, and hypertension; and new insights into the prevention of HF.
- 3. Initial and Serial Evaluation of the HF Patient Biomarkers • Assays for BNP (B-type natriuretic peptide) and NT-proBNP (N- terminal pro-B-type natriuretic peptide), which are both natriuretic peptide biomarkers, have been used increasingly to establish the presence and severity of HF. • Notably, BNP, but not NT-proBNP, is a substrate for neprilysin. Therefore, ARNI increases BNP levels but not NT-proBNP levels..
- 6. Treatment of Stages A to D Stage C Pharmacological Treatment for Stage C HF With Reduced Ejection Fraction
- 7. Treatment of Stages A to D Stage C Pharmacological Treatment for Stage C HF With Reduced Ejection Fraction
- 8. Treatment of Stages A to D Stage C Pharmacological Treatment for Stage C HF With Reduced Ejection Fraction
- 9. Treatment of Stages A to D Stage C Ivabradine: Recommendation
- 13. Pharmacological Treatment for Stage C HFpEF: Recommendations New
- 14. Important Comorbidities in HF Anemia: Recommendations
- 15. Important Comorbidities in HF Hypertension Treating Hypertension to Reduce the Incidence of HF: Recommendation
- 16. Important Comorbidities in HF Hypertension Treating Hypertension in Stage C HFrEF: Recommendation
- 17. Important Comorbidities in HF Hypertension Treating Hypertension in Stage C HFpEF: Recommendation
- 18. Important Comorbidities in HF Sleep Disordered Breathing: Recommendations