Approach to evaluating and treating Chronic Heart Failure and Acute Heart Failure
Reference: Harrison’s Principles of internal medicine Harrison's 21st Ed (2022)
This document provides an overview of atrial fibrillation (AF) and paroxysmal supraventricular tachycardia (PSVT). It defines these conditions and describes their typical ECG patterns, mechanisms, clinical presentations, diagnostic evaluations, and treatment approaches including medications, procedures like cardioversion and ablation. Key points include: AF can be paroxysmal, persistent or permanent, and is caused by mechanisms like reentry and ectopic automaticity; evaluation involves assessing thromboembolic risk with scores like CHA2DS2-VASc; treatment focuses on rate or rhythm control with medications or ablation, while preventing thromboembolism with anticoagulation; PSVT often presents with abrupt
This document summarizes the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. It discusses changes and recommendations for several areas: HFrEF, HFmrEF, HFpEF, advanced HF, and acute HF. For HFrEF, it emphasizes initiating the four key drug therapies as quickly as possible. For HFmrEF, it introduces a new definition and recommends treatments similar to HFrEF. For HFpEF, it stresses actively searching for underlying causes and trial results.
Acute heart failure (AHF) is defined as rapid onset of new or worsening signs and symptoms of heart failure. It represents a life-threatening condition requiring treatment for fluid overload and hemodynamic compromise. Presentation may be initial diagnosis with symptoms and signs of AHF or acute decompensation of pre-existing cardiomyopathy. Hemodynamic instability results from disorders of the myocardium, valves, conduction system or pericardium, in isolation or combination. Potentially treatable causes, e.g. acute coronary syndromes, must be diagnosed and managed early for restoration of function.
Physiological changes associated with AHF result in reduced cardiac output and end-organ hypoperfusion. Once potentially treatable causes are managed, stratification of patients by clinical presentation guides further therapeutic intervention. AHF patients can be categorized as either ‘wet’ or ‘dry’ by clinical fluid status assessment, and either ‘cold’ or ‘warm’ according to perfusion status. In combination, these features identify four patient groups (‘warm-wet’, ‘warm-dry’, ‘cold-dry’, ‘cold-wet’) that guide therapy and facilitate prognostication. ‘Warm-dry’ patients rarely require intensive care for AHF treatment but may benefit from escalation of oral therapeutic regimen. Patients who examine as ‘cold-dry’ may benefit from fluid challenge, and/or inotropic agent infusion. ‘Warm-wet’ patients present with predominantly congestive or hypertensive symptoms which benefit from diuresis and vasodilatation. Patients who present ‘wet-cold’ with normal blood pressure (SBP >90) may benefit from vasodilators and diuretics, with inotropic agents for refractory symptoms. Hypotensive ‘wet-cold’ patients (classic cardiogenic shock) require inotropy with or without vasopressor agents, effective diuresis and early consideration of mechanical circulatory support (MCS).
Definitive therapies for AHF depend on underlying cause, and may include coronary artery intervention, valve repair, rhythm control to restore atrio-ventricular synchrony or management of pericardial tamponade. Patients with severe AHF not responsive to standard therapies should be considered for temporary MCS while candidacy for more durable option is explored by the multi-disciplinary team.
The Progression of Hypertensive Heart Disease.From hypertension to heart failuremagdy elmasry
Staging of Hypertensive Heart Disease.Precipitants and clinical sequelae related to LVH and myocardial fibrosis.Imaging in hypertensive heart disease .Differential diagnosis of LVH.Concentric LVH .Eccentric LVH . Concentric remodeling .linking hypertension and atrial fibrillation
Tachy Arrhythmias - Approach to ManagementArun Vasireddy
Tachyarrhythmias are disorders of heart rhythm which may present with a tachycardia i.e. a heart rate >100 bpm.
This article provides an overview of tachyarrhythmias in general and goes on to cover the most common tachyarrhythmias in more detail. The acute management of tachyarrhythmias, in an emergency setting, will be covered in the 'Acute' section of the fastbleep website.
Tachyarrhythmias are clinically important as they can precipitate cardiac arrest, cardiac failure, thromboembolic disease and syncopal events. As such, they crop up time and time again in exam papers and on the wards.
Tachyarrhythmias are classified based on whether they have broad or narrow QRS complexes on the ECG. Broad is defined as >0.12s (or more than 3 small squares on the standard ECG). Narrow is equal to or less than 0.12s. Broad QRS complexes are slower ventricular depolarisations that arise from the ventricles. Narrow complexes are ventricular depolarisations initiated from above the ventricles (known as supraventricular). One important exception is when there is a supraventricular depolarisation conducted through a diseased AV node. This will produce wide QRS complexes despite the rhythm being supraventricular in origin.
A comprehensive approach to Atrial Fibrillation. Everything you need to know about Atrial fibrillation. Including recent 2014 AHA guidelines of management.
Heart failure is a complex clinical syndrome that results from any structural or functional impairment of the heart that limits its ability to fill with or eject blood. The pathophysiology involves neurohormonal activation of the sympathetic nervous system and renin-angiotensin-aldosterone system. Pharmacological treatment focuses on blocking these neurohormonal mechanisms, reducing preload and afterload, and increasing contractility. The goals of therapy are to improve quality of life, relieve symptoms, prevent hospitalizations, and slow disease progression.
This document provides an overview of atrial fibrillation (AF) and paroxysmal supraventricular tachycardia (PSVT). It defines these conditions and describes their typical ECG patterns, mechanisms, clinical presentations, diagnostic evaluations, and treatment approaches including medications, procedures like cardioversion and ablation. Key points include: AF can be paroxysmal, persistent or permanent, and is caused by mechanisms like reentry and ectopic automaticity; evaluation involves assessing thromboembolic risk with scores like CHA2DS2-VASc; treatment focuses on rate or rhythm control with medications or ablation, while preventing thromboembolism with anticoagulation; PSVT often presents with abrupt
This document summarizes the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. It discusses changes and recommendations for several areas: HFrEF, HFmrEF, HFpEF, advanced HF, and acute HF. For HFrEF, it emphasizes initiating the four key drug therapies as quickly as possible. For HFmrEF, it introduces a new definition and recommends treatments similar to HFrEF. For HFpEF, it stresses actively searching for underlying causes and trial results.
Acute heart failure (AHF) is defined as rapid onset of new or worsening signs and symptoms of heart failure. It represents a life-threatening condition requiring treatment for fluid overload and hemodynamic compromise. Presentation may be initial diagnosis with symptoms and signs of AHF or acute decompensation of pre-existing cardiomyopathy. Hemodynamic instability results from disorders of the myocardium, valves, conduction system or pericardium, in isolation or combination. Potentially treatable causes, e.g. acute coronary syndromes, must be diagnosed and managed early for restoration of function.
Physiological changes associated with AHF result in reduced cardiac output and end-organ hypoperfusion. Once potentially treatable causes are managed, stratification of patients by clinical presentation guides further therapeutic intervention. AHF patients can be categorized as either ‘wet’ or ‘dry’ by clinical fluid status assessment, and either ‘cold’ or ‘warm’ according to perfusion status. In combination, these features identify four patient groups (‘warm-wet’, ‘warm-dry’, ‘cold-dry’, ‘cold-wet’) that guide therapy and facilitate prognostication. ‘Warm-dry’ patients rarely require intensive care for AHF treatment but may benefit from escalation of oral therapeutic regimen. Patients who examine as ‘cold-dry’ may benefit from fluid challenge, and/or inotropic agent infusion. ‘Warm-wet’ patients present with predominantly congestive or hypertensive symptoms which benefit from diuresis and vasodilatation. Patients who present ‘wet-cold’ with normal blood pressure (SBP >90) may benefit from vasodilators and diuretics, with inotropic agents for refractory symptoms. Hypotensive ‘wet-cold’ patients (classic cardiogenic shock) require inotropy with or without vasopressor agents, effective diuresis and early consideration of mechanical circulatory support (MCS).
Definitive therapies for AHF depend on underlying cause, and may include coronary artery intervention, valve repair, rhythm control to restore atrio-ventricular synchrony or management of pericardial tamponade. Patients with severe AHF not responsive to standard therapies should be considered for temporary MCS while candidacy for more durable option is explored by the multi-disciplinary team.
The Progression of Hypertensive Heart Disease.From hypertension to heart failuremagdy elmasry
Staging of Hypertensive Heart Disease.Precipitants and clinical sequelae related to LVH and myocardial fibrosis.Imaging in hypertensive heart disease .Differential diagnosis of LVH.Concentric LVH .Eccentric LVH . Concentric remodeling .linking hypertension and atrial fibrillation
Tachy Arrhythmias - Approach to ManagementArun Vasireddy
Tachyarrhythmias are disorders of heart rhythm which may present with a tachycardia i.e. a heart rate >100 bpm.
This article provides an overview of tachyarrhythmias in general and goes on to cover the most common tachyarrhythmias in more detail. The acute management of tachyarrhythmias, in an emergency setting, will be covered in the 'Acute' section of the fastbleep website.
Tachyarrhythmias are clinically important as they can precipitate cardiac arrest, cardiac failure, thromboembolic disease and syncopal events. As such, they crop up time and time again in exam papers and on the wards.
Tachyarrhythmias are classified based on whether they have broad or narrow QRS complexes on the ECG. Broad is defined as >0.12s (or more than 3 small squares on the standard ECG). Narrow is equal to or less than 0.12s. Broad QRS complexes are slower ventricular depolarisations that arise from the ventricles. Narrow complexes are ventricular depolarisations initiated from above the ventricles (known as supraventricular). One important exception is when there is a supraventricular depolarisation conducted through a diseased AV node. This will produce wide QRS complexes despite the rhythm being supraventricular in origin.
A comprehensive approach to Atrial Fibrillation. Everything you need to know about Atrial fibrillation. Including recent 2014 AHA guidelines of management.
Heart failure is a complex clinical syndrome that results from any structural or functional impairment of the heart that limits its ability to fill with or eject blood. The pathophysiology involves neurohormonal activation of the sympathetic nervous system and renin-angiotensin-aldosterone system. Pharmacological treatment focuses on blocking these neurohormonal mechanisms, reducing preload and afterload, and increasing contractility. The goals of therapy are to improve quality of life, relieve symptoms, prevent hospitalizations, and slow disease progression.
Presentation about heart failure with preserved ejection fraction. Current epidemiology, pathophysiology, diagnostic approac and evidence-based treatment are presented.
1. The document discusses various cardiac arrhythmias including supraventricular tachycardias, atrial fibrillation, ventricular tachycardia, and ventricular fibrillation.
2. It provides details on characteristics, causes, diagnosis, and treatment of these arrhythmias based on American and European cardiology guidelines.
3. The treatment discussed includes electrical cardioversion, antiarrhythmic medications, catheter ablation, and implantable cardioverter defibrillators.
This document provides guidelines for treating heart failure cases using the 2016 ESC Guidelines. It defines heart failure and discusses diagnostic algorithms. It presents 4 clinical case scenarios to illustrate how to apply guideline recommendations in primary care patients presenting with heart failure symptoms. For each case, it analyzes diagnostic tests, identifies treatments, and describes how to initiate and titrate medications like ACE inhibitors and beta-blockers. The document also covers topics like imaging tests, classifications of heart failure, treatment objectives, and algorithms for managing reduced ejection fraction.
2022 Guideline for the Management of Heart Failure Clinical Update.pptxsubhankar16
This document summarizes guidelines from the 2022 AHA/ACC/HFSA for the diagnosis and management of heart failure. It defines the stages of heart failure from A to D and discusses evaluation, causes, biomarkers, imaging, and invasive testing. Key recommendations include using biomarkers like BNP and NT-proBNP to diagnose and manage HF. Transthoracic echocardiography is recommended for initial evaluation, and cardiac MRI, CT, or nuclear imaging if echo is inadequate. Invasive procedures are not routinely recommended but may help in select cases. Remote monitoring can benefit some patients with advanced HF.
This document discusses the clinical approach to evaluating patients presenting with palpitations. It defines palpitations and describes the physiology and common causes. Cardiac causes account for 43% of cases, while psychiatric conditions cause 31%. The document outlines the diagnostic evaluation including history, physical exam, ECG and ambulatory monitoring. It provides guidance on when to refer to cardiology or admit to the hospital. The management focuses on reassurance, lifestyle changes, treating underlying conditions, anxiolytics, beta-blockers, antiarrhythmics or cardioversion depending on the severity and nature of the arrhythmia.
This document provides an overview of atrial fibrillation (AF), including its pathogenesis, types, diagnosis, and management. Some key points:
- AF is the most common cardiac arrhythmia, affecting around 6% of those over 65. It increases the risk of stroke.
- It occurs when the normal sinus rhythm is overridden by disorganized electrical impulses, usually originating in the lungs.
- Types include paroxysmal, persistent, and permanent. Symptoms range from none to palpitations, dyspnea, chest pain, and neurological issues.
- Diagnosis is made via ECG showing irregular rhythm without P waves. Workup evaluates for underlying causes and stroke risk factors.
This document summarizes pulmonary hypertension and its management. It discusses the pulmonary circulation and pressures, types and classification of pulmonary hypertension, pathogenesis involving various molecular pathways, clinical diagnosis using echocardiography, right heart catheterization, and treatment goals and strategies. The main treatment approaches discussed are calcium channel blockers, prostanoids, endothelin receptor antagonists, phosphodiesterase inhibitors, and soluble guanylate cyclase stimulators. The goals of treatment are to palliate symptoms, improve exercise tolerance and right ventricular function, and strive to improve survival rates.
Atrial fibrillation is the most common cardiac arrhythmia. It is characterized by irregular heart rhythms without distinct P waves due to irregular activation of the atria. The prevalence increases with age and is higher in men. Risk factors include hypertension, heart disease, heart failure, thyroid disorders, obesity, and lung disease. If left untreated, atrial fibrillation can lead to stroke, heart failure, reduced quality of life, and death. The pathogenesis involves multiple activation wavelets in the atria which causes the muscle to shorten its refractory period, making further arrhythmias more likely. Atrial fibrillation is classified based on its pattern and duration.
Practical approach to fever with altered liver functionsikramdr01
This document provides information on evaluating and diagnosing a patient presenting with fever and abnormal liver function tests. It discusses the differential diagnosis, which includes conditions like malaria, typhoid, leptospirosis, viral hepatitis, infectious mononucleosis, herpes, tuberculosis, autoimmune diseases, and liver abscesses. Specific diagnostic criteria and clinical features of various conditions are outlined, along with diagnostic tests and approaches. Imaging modalities like ultrasound and their findings for conditions like cholecystitis and liver abscesses are also reviewed. The document provides an overview of evaluating causes of drug-induced liver injury.
The document discusses pericardial disease and acute pericarditis. Acute pericarditis is defined as inflammation of the pericardium lasting less than 2 weeks. Common causes include viral or bacterial infections, tuberculosis, renal failure and idiopathic. Clinical features include chest pain relieved by sitting forward and pericardial rub. Investigations include EKG showing PR depression and ST elevation, echocardiogram detecting pericardial fluid, and pericardiocentesis if suspicion of infection or tamponade. Treatment involves NSAIDs or colchicine and complications can include recurrent pericarditis or constriction.
This document contains mnemonics and summaries to aid in remembering various concepts in cardiology. It includes summaries of aortic stenosis characteristics, management of myocardial infarction, causes of pericarditis, heart compensatory mechanisms, distinguishing right and left heart murmurs, causes of ST elevation on ECG, Beck's triad signs, and treatment for myocardial infarction. It also includes mnemonics for jugular venous pressure causes, depressed ST-segment causes, innocent murmur features, murmur locations, cardioselective betablockers, and more.
Rheumatic valvular heart disease is caused by rheumatic fever, an inflammatory response to Group A streptococcal infection. It most commonly results in mitral regurgitation or stenosis from scarring of the mitral valve. Physical exam may reveal murmurs. Echocardiography is the gold standard for assessing valve structure and function. Long-term management involves serial monitoring, medications to control symptoms, and possibly surgery for severe or symptomatic cases. Complications include heart failure, arrhythmias, embolism and infective endocarditis.
1. Atrial fibrillation (AF) is a common arrhythmia where abnormal electrical signals in the atria cause an irregular heartbeat.
2. AF increases the risk of stroke by 5 times and is associated with increased mortality, hospitalization, and decreased quality of life.
3. Management involves rate or rhythm control as well as anticoagulation to prevent stroke, with treatment depending on factors like symptoms, age, and stroke risk level.
ECG-T wave inversion , Dr. Malala Rajapaksha ,Cardiology unit,General Hospit...malala720
This is a presentation on “What are the deferential Diagnosis a clinician think of when the clinician encounter T inversions in an ECG of a patient”. This will be help full in day today clinical practice and also in academic purposes.
This document summarizes information on anemia in heart failure patients. Some key points:
1. The prevalence of anemia in heart failure patients ranges from 20-30% for outpatients to 30-40% for inpatients, depending on the definition and study.
2. Anemia is associated with worse prognosis and increased risk of hospitalization and mortality in heart failure patients.
3. Potential treatment options for anemia in heart failure include blood transfusions, erythropoietin-stimulating proteins (ESPs), and iron therapy. However, clinical trials of ESPs like darbepoetin alfa have not shown clear benefits.
4. The FAIR-HF trial found
This document discusses the assessment of severity in valvular heart disease. It addresses three main issues in managing patients with valvular heart disease: assessing disease severity, determining the effect on the cardiovascular system, and deciding the timing and type of intervention. Disease severity is classified as mild, moderate, or severe based on physical exam findings, echocardiography, and other tests. Only severe disease generally causes symptoms and requires intervention. Assessment of severity integrates data from multiple tests and should guide decisions about treatment.
Cardiorenal syndrome (CRS) refers to conditions where acute or chronic dysfunction of the heart or kidneys induces dysfunction of the other organ. CRS is classified into 5 subtypes depending on whether cardiac or renal dysfunction occurs first, and whether it is acute or chronic. Type 1 involves acute cardiac dysfunction leading to acute kidney injury. Type 2 involves chronic cardiac dysfunction resulting in worsening chronic kidney disease. Type 3 involves acute kidney injury leading to cardiac issues. Type 4 involves chronic kidney disease contributing to cardiac problems. Type 5 involves systemic conditions affecting both organs. Early diagnosis and treatment tailored to the CRS subtype is important for improving outcomes.
Torsades de pointes is a type of ventricular tachycardia where the QRS complex twists around the isoelectric baseline on an ECG. It is associated with a prolonged QT interval from long QT syndrome. Torsades de pointes can be triggered by an R-on-T premature ventricular contraction and can degenerate into ventricular fibrillation if not treated. Treatment involves withdrawing any offending drugs, administering magnesium sulfate, antiarrhythmic medications, and electrical cardioversion or defibrillation as needed.
Approach to evaluating and treating Chronic Heart Failure and Acute Heart Failure
Reference: Harrison’s Principles of internal medicine Harrison's 21st Ed (2022)
download notes of the presentation and study with its print out
This document provides an overview of several common critical medical conditions including respiratory failure, ARDS, acute MI, CHF, GI bleed, DKA, shock, and sepsis. It defines each condition and discusses signs and symptoms, causes, complications, treatments, and nursing interventions. Respiratory failure can result from ventilation-perfusion mismatching or intrapulmonary shunting. ARDS causes damage to the alveolar-capillary interface leading to pulmonary edema. Acute MI is caused by coronary artery obstruction from thrombus or plaque. CHF occurs when the heart cannot pump sufficient blood to meet metabolic needs.
Presentation about heart failure with preserved ejection fraction. Current epidemiology, pathophysiology, diagnostic approac and evidence-based treatment are presented.
1. The document discusses various cardiac arrhythmias including supraventricular tachycardias, atrial fibrillation, ventricular tachycardia, and ventricular fibrillation.
2. It provides details on characteristics, causes, diagnosis, and treatment of these arrhythmias based on American and European cardiology guidelines.
3. The treatment discussed includes electrical cardioversion, antiarrhythmic medications, catheter ablation, and implantable cardioverter defibrillators.
This document provides guidelines for treating heart failure cases using the 2016 ESC Guidelines. It defines heart failure and discusses diagnostic algorithms. It presents 4 clinical case scenarios to illustrate how to apply guideline recommendations in primary care patients presenting with heart failure symptoms. For each case, it analyzes diagnostic tests, identifies treatments, and describes how to initiate and titrate medications like ACE inhibitors and beta-blockers. The document also covers topics like imaging tests, classifications of heart failure, treatment objectives, and algorithms for managing reduced ejection fraction.
2022 Guideline for the Management of Heart Failure Clinical Update.pptxsubhankar16
This document summarizes guidelines from the 2022 AHA/ACC/HFSA for the diagnosis and management of heart failure. It defines the stages of heart failure from A to D and discusses evaluation, causes, biomarkers, imaging, and invasive testing. Key recommendations include using biomarkers like BNP and NT-proBNP to diagnose and manage HF. Transthoracic echocardiography is recommended for initial evaluation, and cardiac MRI, CT, or nuclear imaging if echo is inadequate. Invasive procedures are not routinely recommended but may help in select cases. Remote monitoring can benefit some patients with advanced HF.
This document discusses the clinical approach to evaluating patients presenting with palpitations. It defines palpitations and describes the physiology and common causes. Cardiac causes account for 43% of cases, while psychiatric conditions cause 31%. The document outlines the diagnostic evaluation including history, physical exam, ECG and ambulatory monitoring. It provides guidance on when to refer to cardiology or admit to the hospital. The management focuses on reassurance, lifestyle changes, treating underlying conditions, anxiolytics, beta-blockers, antiarrhythmics or cardioversion depending on the severity and nature of the arrhythmia.
This document provides an overview of atrial fibrillation (AF), including its pathogenesis, types, diagnosis, and management. Some key points:
- AF is the most common cardiac arrhythmia, affecting around 6% of those over 65. It increases the risk of stroke.
- It occurs when the normal sinus rhythm is overridden by disorganized electrical impulses, usually originating in the lungs.
- Types include paroxysmal, persistent, and permanent. Symptoms range from none to palpitations, dyspnea, chest pain, and neurological issues.
- Diagnosis is made via ECG showing irregular rhythm without P waves. Workup evaluates for underlying causes and stroke risk factors.
This document summarizes pulmonary hypertension and its management. It discusses the pulmonary circulation and pressures, types and classification of pulmonary hypertension, pathogenesis involving various molecular pathways, clinical diagnosis using echocardiography, right heart catheterization, and treatment goals and strategies. The main treatment approaches discussed are calcium channel blockers, prostanoids, endothelin receptor antagonists, phosphodiesterase inhibitors, and soluble guanylate cyclase stimulators. The goals of treatment are to palliate symptoms, improve exercise tolerance and right ventricular function, and strive to improve survival rates.
Atrial fibrillation is the most common cardiac arrhythmia. It is characterized by irregular heart rhythms without distinct P waves due to irregular activation of the atria. The prevalence increases with age and is higher in men. Risk factors include hypertension, heart disease, heart failure, thyroid disorders, obesity, and lung disease. If left untreated, atrial fibrillation can lead to stroke, heart failure, reduced quality of life, and death. The pathogenesis involves multiple activation wavelets in the atria which causes the muscle to shorten its refractory period, making further arrhythmias more likely. Atrial fibrillation is classified based on its pattern and duration.
Practical approach to fever with altered liver functionsikramdr01
This document provides information on evaluating and diagnosing a patient presenting with fever and abnormal liver function tests. It discusses the differential diagnosis, which includes conditions like malaria, typhoid, leptospirosis, viral hepatitis, infectious mononucleosis, herpes, tuberculosis, autoimmune diseases, and liver abscesses. Specific diagnostic criteria and clinical features of various conditions are outlined, along with diagnostic tests and approaches. Imaging modalities like ultrasound and their findings for conditions like cholecystitis and liver abscesses are also reviewed. The document provides an overview of evaluating causes of drug-induced liver injury.
The document discusses pericardial disease and acute pericarditis. Acute pericarditis is defined as inflammation of the pericardium lasting less than 2 weeks. Common causes include viral or bacterial infections, tuberculosis, renal failure and idiopathic. Clinical features include chest pain relieved by sitting forward and pericardial rub. Investigations include EKG showing PR depression and ST elevation, echocardiogram detecting pericardial fluid, and pericardiocentesis if suspicion of infection or tamponade. Treatment involves NSAIDs or colchicine and complications can include recurrent pericarditis or constriction.
This document contains mnemonics and summaries to aid in remembering various concepts in cardiology. It includes summaries of aortic stenosis characteristics, management of myocardial infarction, causes of pericarditis, heart compensatory mechanisms, distinguishing right and left heart murmurs, causes of ST elevation on ECG, Beck's triad signs, and treatment for myocardial infarction. It also includes mnemonics for jugular venous pressure causes, depressed ST-segment causes, innocent murmur features, murmur locations, cardioselective betablockers, and more.
Rheumatic valvular heart disease is caused by rheumatic fever, an inflammatory response to Group A streptococcal infection. It most commonly results in mitral regurgitation or stenosis from scarring of the mitral valve. Physical exam may reveal murmurs. Echocardiography is the gold standard for assessing valve structure and function. Long-term management involves serial monitoring, medications to control symptoms, and possibly surgery for severe or symptomatic cases. Complications include heart failure, arrhythmias, embolism and infective endocarditis.
1. Atrial fibrillation (AF) is a common arrhythmia where abnormal electrical signals in the atria cause an irregular heartbeat.
2. AF increases the risk of stroke by 5 times and is associated with increased mortality, hospitalization, and decreased quality of life.
3. Management involves rate or rhythm control as well as anticoagulation to prevent stroke, with treatment depending on factors like symptoms, age, and stroke risk level.
ECG-T wave inversion , Dr. Malala Rajapaksha ,Cardiology unit,General Hospit...malala720
This is a presentation on “What are the deferential Diagnosis a clinician think of when the clinician encounter T inversions in an ECG of a patient”. This will be help full in day today clinical practice and also in academic purposes.
This document summarizes information on anemia in heart failure patients. Some key points:
1. The prevalence of anemia in heart failure patients ranges from 20-30% for outpatients to 30-40% for inpatients, depending on the definition and study.
2. Anemia is associated with worse prognosis and increased risk of hospitalization and mortality in heart failure patients.
3. Potential treatment options for anemia in heart failure include blood transfusions, erythropoietin-stimulating proteins (ESPs), and iron therapy. However, clinical trials of ESPs like darbepoetin alfa have not shown clear benefits.
4. The FAIR-HF trial found
This document discusses the assessment of severity in valvular heart disease. It addresses three main issues in managing patients with valvular heart disease: assessing disease severity, determining the effect on the cardiovascular system, and deciding the timing and type of intervention. Disease severity is classified as mild, moderate, or severe based on physical exam findings, echocardiography, and other tests. Only severe disease generally causes symptoms and requires intervention. Assessment of severity integrates data from multiple tests and should guide decisions about treatment.
Cardiorenal syndrome (CRS) refers to conditions where acute or chronic dysfunction of the heart or kidneys induces dysfunction of the other organ. CRS is classified into 5 subtypes depending on whether cardiac or renal dysfunction occurs first, and whether it is acute or chronic. Type 1 involves acute cardiac dysfunction leading to acute kidney injury. Type 2 involves chronic cardiac dysfunction resulting in worsening chronic kidney disease. Type 3 involves acute kidney injury leading to cardiac issues. Type 4 involves chronic kidney disease contributing to cardiac problems. Type 5 involves systemic conditions affecting both organs. Early diagnosis and treatment tailored to the CRS subtype is important for improving outcomes.
Torsades de pointes is a type of ventricular tachycardia where the QRS complex twists around the isoelectric baseline on an ECG. It is associated with a prolonged QT interval from long QT syndrome. Torsades de pointes can be triggered by an R-on-T premature ventricular contraction and can degenerate into ventricular fibrillation if not treated. Treatment involves withdrawing any offending drugs, administering magnesium sulfate, antiarrhythmic medications, and electrical cardioversion or defibrillation as needed.
Approach to evaluating and treating Chronic Heart Failure and Acute Heart Failure
Reference: Harrison’s Principles of internal medicine Harrison's 21st Ed (2022)
download notes of the presentation and study with its print out
This document provides an overview of several common critical medical conditions including respiratory failure, ARDS, acute MI, CHF, GI bleed, DKA, shock, and sepsis. It defines each condition and discusses signs and symptoms, causes, complications, treatments, and nursing interventions. Respiratory failure can result from ventilation-perfusion mismatching or intrapulmonary shunting. ARDS causes damage to the alveolar-capillary interface leading to pulmonary edema. Acute MI is caused by coronary artery obstruction from thrombus or plaque. CHF occurs when the heart cannot pump sufficient blood to meet metabolic needs.
This document discusses heart failure with preserved ejection fraction (HFpEF). It begins by defining HFpEF and noting that approximately half of heart failure patients have normal or near-normal ejection fractions. The document then reviews various classification systems for HF, diagnostic criteria, echocardiographic assessment of HFpEF, risk factors, and challenges in diagnosing and treating HFpEF. It concludes by discussing current and potential future treatment approaches for HFpEF, including drugs targeting comorbid conditions that are common in HFpEF patients.
This document discusses heart failure with preserved ejection fraction (HFpEF). It defines HFpEF and describes the pathophysiology as being related to diastolic dysfunction from impaired relaxation and stiffness of the left ventricle. Common causes include hypertension, coronary artery disease, and obesity. Patients typically present with signs and symptoms of congestion. Echocardiography is used to diagnose HFpEF by showing preserved ejection fraction and evidence of diastolic dysfunction. Treatment focuses on controlling hypertension, congestion with diuretics, and some evidence that ARBs and spironolactone may reduce hospitalizations for HFpEF patients.
A 22-year-old male presented with complaints of easy fatigability, abdominal discomfort, leg swelling, and shortness of breath with exertion over the past 6-8 months. Examination found edema, elevated jugular venous pressure, hepatomegaly, and cachexia. Testing showed elevated liver enzymes and BNP. Echocardiogram demonstrated thickened pericardium with ventricular interdependence and equal diastolic pressures, consistent with constrictive pericarditis. The patient was diagnosed with constrictive pericarditis likely due to a prior unknown infection or inflammatory process causing thickening and scarring of the pericardium.
The third presentation in my ACEM Fellowship Summary series. Focuses on the aetiology, diagnosis and management of acute heart failure in its many forms.
1) Congestive heart failure results from any structural or functional abnormality that impairs the ventricle's ability to eject or fill with blood.
2) The renin-angiotensin-aldosterone system plays a role in the vicious cycle of congestive heart failure by stimulating sodium and water retention.
3) Treatment for systolic heart failure involves correcting underlying factors, lifestyle modifications, and maximizing medications like loop diuretics, ACE inhibitors, beta blockers, and aldosterone antagonists.
1) Congestive heart failure results from any structural or functional abnormality that impairs the ventricle's ability to eject or fill with blood.
2) The renin-angiotensin-aldosterone system plays a role in the vicious cycle of congestive heart failure by stimulating sodium and water retention.
3) Treatment for systolic heart failure involves lifestyle modifications, medications like diuretics, ACE inhibitors, beta blockers, and devices or transplantation for refractory cases.
Acute Decompensated Heart Failure : What is New ?drucsamal
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
Calcium released from the sarcoplasmic reticulum in cardiac myocytes stimulates contraction. Calcium is reuptaken into the sarcoplasmic reticulum and effluxed from the cell, lowering intracellular calcium as contraction peaks. Heart failure is defined by symptoms such as breathlessness and signs such as elevated jugular venous pressure. It requires evidence of structural heart abnormality and impaired function.
The document discusses shock in children, defining it as circulatory system failure to supply oxygen and nutrients to meet cellular demands. It covers circulatory physiology, classifications of shock, evaluation, treatment including fluid resuscitation and vasoactive drugs, and specific types of shock such as hypovolemic, cardiogenic, obstructive, and distributive shock. Metabolic issues associated with shock like acid-base and electrolyte abnormalities are also reviewed.
Lec 5 management of heart failure for mohsEhealthMoHS
This document provides information on chronic heart failure, including its definition, causes, symptoms, diagnostic tests, management, and treatment options. Key points include: heart failure is defined as a clinical syndrome with symptoms caused by structural/functional cardiac issues leading to reduced cardiac output; common causes are coronary artery disease, hypertension, and cardiomyopathy; symptoms include breathlessness, ankle swelling, and fatigue; diagnostic tests include echocardiogram, chest x-ray, and natriuretic peptide levels; management involves treating the underlying cause, reducing exacerbating factors, and pharmacological therapy including ACE inhibitors, beta blockers, diuretics, and device-based therapies for intractable cases.
This document discusses pulmonary hypertension (PH), including its definition, classification, pathophysiology, diagnosis, and management in intensive care patients. It defines PH as a mean pulmonary artery pressure >25 mmHg and outlines the various causes classified under five groups. The pathophysiology of PH involves vasoconstriction, vascular remodeling, thrombosis and endothelial dysfunction. Diagnosis involves history, physical exam, imaging like chest X-ray and ECG, as well as right heart catheterization. Management focuses on treating the underlying cause, using vasodilators, inotropes to support the right ventricle, diuretics, oxygen therapy and potentially surgery in refractory cases. PH increases mortality and deteriorations can be rapid
1) Pulmonary hypertension is defined as a systolic pulmonary artery pressure >35mmHg or mean pulmonary artery pressure >25mmHg and is classified into 5 groups. Group 1 includes pulmonary arterial hypertension which can be idiopathic or associated with other conditions.
2) Pulmonary hypertension results from an imbalance between vasoconstrictors like endothelin-1 and vasodilators like nitric oxide leading to vascular remodeling and increased pulmonary pressures. Acute pulmonary hypertension in the ICU is often caused by conditions like pulmonary embolism, lung disease, heart disease or sepsis.
3) Diagnosis involves clinical exam, imaging like echocardiogram and right heart catheterization. Treatment goals are to reduce pulmonary pressures
The document summarizes heart failure, including its causes, pathophysiology, clinical presentation, investigation, classification, treatment, and prognosis. Heart failure represents the inability of the heart to pump enough blood to meet the body's needs. It can be caused by conditions that impair the heart muscle or overload it. The pathophysiology involves neurohormonal activation that maladaptively remodels the heart. Treatment involves managing symptoms, preventing progression, and correcting reversible causes. Prognosis depends on disease stage, with 5-year mortality of 50% and annual mortality rates ranging from 5-30% depending on severity.
It includes emergency situations related to the cardiovascular aspect of humans. it focuses on the critical care aspect to manage certain emergencies. Nursing care is also included thus, fosters a better aspect of nursing individuals to manage a cardiovascular emergency.
Heart failure is a clinical syndrome where the heart cannot pump enough blood to meet the body's needs. It affects over 64 million people worldwide and is a leading cause of hospitalization. It can be caused by structural or functional issues with the heart. Heart failure is classified based on whether the left side, right side, or both ventricles are affected, and ejection fraction. Common causes include coronary artery disease and hypertension. Symptoms include dyspnea, fatigue, edema and reduced exercise capacity. Treatment involves medications to reduce preload, afterload, heart rate and prevent remodeling, as well as diuretics, device therapies, surgery and transplantation in advanced cases.
Drugs used for the Treatment of Heart failurenetraangadi2
This document provides an overview of heart failure, including its pathophysiology, causes, mechanisms, adaptive responses, and treatment approaches. It describes how heart failure results from structural or functional cardiac disorders that impair the ventricle's ability to fill or eject blood. Common causes are listed as well as the mechanisms that lead to heart failure, such as impaired contractility or ventricular filling/outflow. The adaptive responses that initially compensate but later become pathological are explained. The document then discusses therapeutic approaches for acute and chronic heart failure, focusing on relieving symptoms, correcting underlying causes, and preventing further deterioration. Specific drug classes are outlined with regards to their mechanisms and goals in managing heart failure.
This document discusses the evaluation and management of palpitations. It begins with definitions and introduces common causes of palpitations including arrhythmias, augmentation of heart contractility, and cardiac neurosis. The diagnostic pathway involves obtaining a thorough history, physical exam including ECG, and potential additional testing such as echocardiogram, Holter monitor, or cardiac MRI if indicated. The document provides details on the diagnostic criteria and clinical findings of various cardiac and extracardiac conditions that can cause palpitations. Management is tailored based on the underlying cause.
1. Sepsis is a life-threatening organ dysfunction caused by a dysregulated immune response to infection. It can progress to septic shock, which involves circulatory and metabolic abnormalities increasing the risk of death.
2. Initial management of sepsis involves screening, resuscitation, infection control, hemodynamic support, and empiric antibiotics within 1-3 hours while obtaining cultures. Ongoing care focuses on organ support, source control, and monitoring for complications.
3. Long term goals include preventing disability, addressing psychosocial needs, and smooth transition to post-acute care and follow up. Prompt recognition and treatment can reduce mortality from this medical emergency.
A 24-year-old woman presented with headache and left-sided weakness. Imaging showed cerebral venous thrombosis involving the superior sagittal sinus and draining veins. She was diagnosed with antiphospholipid syndrome based on recurrent pregnancy loss and positive lupus anticoagulant. She was treated with anticoagulation and anticonvulsants and showed gradual improvement over 10 days with residual mild weakness. Her long-term management plan includes lifelong anticoagulation and screening for recurrent thrombosis.
A 68-year-old male farmer presented with post-traumatic T3-T4 compression fracture and paraplegia in January 2022. He developed recurrent UTIs, hemorrhagic pleural effusion, and a retropharyngeal cyst requiring debulking. In early March, he developed cough, dyspnea, stridor and altered sensorium. He was diagnosed with right lower lobe pneumonia, sepsis and respiratory failure. Treatment included antibiotics, ventilation, and supportive care. He later developed bilateral vocal cord palsy and was discharged at family's request before further evaluation.
Chronic myeloid leukemia (CML) is a stem cell disorder caused by the Philadelphia chromosome, which results from the fusion of the BCR gene on chromosome 22 and the ABL gene on chromosome 9. This fusion produces the BCR-ABL protein which exhibits uncontrolled tyrosine kinase activity, driving excessive proliferation of CML cells. CML progresses through chronic, accelerated and blast crisis phases as additional genetic mutations accumulate. Tyrosine kinase inhibitors (TKIs) target the BCR-ABL protein and have significantly improved survival, with a 10-year survival of 85% with TKI therapy. Monitoring response through cytogenetics, FISH and molecular testing guides treatment decisions such as changing or adding other TKIs.
LECTURE ON ATRIAL FIBRILLATION TO 9TH TERM MEDICAL STUDENTS REFERENCES: DAVIDSON(2018) HARRISON 20TH ED OF MEDICINE AND 2020 EUROPEAN HEART GUIDELINES ON AF
surviving sepsis guidelines - Notes are made from surviving sepsis guidelines 2016 article to assist medical students and residents to grasp subject in a easy to read format in a step wise manner. Resources: surviving sepsis guidelines 2016 (free access article)
Pulmonary embolism - Notes are made from textbook of Internal medicine to assist medical students and residents to grasp subject in totality. Resources: Harrison's 20thEd, ESC 2019 guidelines on PE
A pulmonary embolism occurs when a blood clot or other material occludes the pulmonary artery or its branches. This most commonly results from a deep vein thrombosis in the lower leg that embolizes to the lung. When a PE occurs, it causes ventilation-perfusion mismatching in the lungs. Diagnosis is difficult due to nonspecific symptoms but evaluation involves a Wells criteria assessment, D-dimer testing, echocardiogram, and CT pulmonary angiogram. Treatment consists of anticoagulation with low molecular weight heparin or novel oral anticoagulants. Fibrinolytic therapy may be used in massive PEs. Prevention focuses on prophylaxis in high risk hospitalized patients.
Dr. David Greene R3 stem cell Breakthroughs: Stem Cell Therapy in CardiologyR3 Stem Cell
Dr. David Greene, founder and CEO of R3 Stem Cell, is at the forefront of groundbreaking research in the field of cardiology, focusing on the transformative potential of stem cell therapy. His latest work emphasizes innovative approaches to treating heart disease, aiming to repair damaged heart tissue and improve heart function through the use of advanced stem cell techniques. This research promises not only to enhance the quality of life for patients with chronic heart conditions but also to pave the way for new, more effective treatments. Dr. Greene's work is notable for its focus on safety, efficacy, and the potential to significantly reduce the need for invasive surgeries and long-term medication, positioning stem cell therapy as a key player in the future of cardiac care.
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
The best massage spa Ajman is Chandrima Spa Ajman, which was founded in 2023 and is exclusively for men 24 hours a day. As of right now, our parent firm has been providing massage services to over 50,000+ clients in Ajman for the past 10 years. It has about 8+ branches. This demonstrates that Chandrima Spa Ajman is among the most reasonably priced spas in Ajman and the ideal place to unwind and rejuvenate. We provide a wide range of Spa massage treatments, including Indian, Pakistani, Kerala, Malayali, and body-to-body massages. Numerous massage techniques are available, including deep tissue, Swedish, Thai, Russian, and hot stone massages. Our massage therapists produce genuinely unique treatments that generate a revitalized sense of inner serenely by fusing modern techniques, the cleanest natural substances, and traditional holistic therapists.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
KEY Points of Leicester travel clinic In London doc.docxNX Healthcare
In order to protect visitors' safety and wellbeing, Travel Clinic Leicester offers a wide range of travel-related health treatments, including individualized counseling and vaccines. Our team of medical experts specializes in getting people ready for international travel, with a particular emphasis on vaccines and health consultations to prevent travel-related illnesses. We provide a range of travel-related services, such as health concerns unique to a trip, prevention of malaria, and travel-related medical supplies. Our clinic is dedicated to providing top-notch care, keeping abreast of the most recent recommendations for vaccinations and travel health precautions. The goal of Travel Clinic Leicester is to keep you safe and well-rested no matter what kind of travel you choose—business, pleasure, or adventure.
Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...The Lifesciences Magazine
Cold Sores, medically known as herpes labialis, are caused by the herpes simplex virus (HSV). HSV-1 is primarily responsible for cold sores, although HSV-2 can also contribute in some cases.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
Healthy Eating Habits:
Understanding Nutrition Labels: Teaches how to read and interpret food labels, focusing on serving sizes, calorie intake, and nutrients to limit or include.
Tips for Healthy Eating: Offers practical advice such as incorporating a variety of foods, practicing moderation, staying hydrated, and eating mindfully.
Benefits of Regular Exercise:
Physical Benefits: Discusses how exercise aids in weight management, muscle and bone health, cardiovascular health, and flexibility.
Mental Benefits: Explains the psychological advantages, including stress reduction, improved mood, and better sleep.
Tips for Staying Active:
Encourages consistency, variety in exercises, setting realistic goals, and finding enjoyable activities to maintain motivation.
Maintaining a Balanced Lifestyle:
Integrating Nutrition and Exercise: Suggests meal planning and incorporating physical activity into daily routines.
Monitoring Progress: Recommends tracking food intake and exercise, regular health check-ups, and provides tips for achieving balance, such as getting sufficient sleep, managing stress, and staying socially active.
Feeding plate for a newborn with Cleft Palate.pptxSatvikaPrasad
A feeding plate is a prosthetic device used for newborns with a cleft palate to assist in feeding and improve nutrition intake. From a prosthodontic perspective, this plate acts as a barrier between the oral and nasal cavities, facilitating effective sucking and swallowing by providing a more normal anatomical structure. It helps to prevent milk from entering the nasal passage, thereby reducing the risk of aspiration and enhancing the infant's ability to feed efficiently. The feeding plate also aids in the development of the oral muscles and can contribute to better growth and weight gain. Its custom fabrication and proper fitting by a prosthodontist are crucial for ensuring comfort and functionality, as well as for minimizing potential complications. Early intervention with a feeding plate can significantly improve the quality of life for both the infant and the parents.
Feeding plate for a newborn with Cleft Palate.pptx
Heart Failure Approach class.pptx
1. Col Bharat Malhotra
Senior Advisor (Medicine)
REFERENCE
Harrison’s Principles of internal medicine Harrison's 21st Ed (2022)
Davidson’s Principles and practice of Medicine (2018)
AHA & European Guidelines on management of Acute and Chronic Heart Failure (2021 & 2022)
2. Incidence and Prevalence of HF worldwide
PREVALENCE
Developed Countries: 2%
Asia : 0.1 -7%
India : 0.12- 0.44%
40-60 yrs: 1-2%
> 80 years: 12%
3. • Complex clinical syndrome
• that results from structural or functional impairment
• of ventricular filling or ejection of blood
• leads to cardinal manifestation of dyspnea and
fatigue and fluid retention
American Heart Association Cardiology Guidelines (2022)
4. Chronic HF describes those who have had an established
long-standing diagnosis of HF or who have a more gradual
onset of symptoms.
Acute HF is rapid onset of new or worsening of
preexisting HF requiring hospitalization.
In pathophysiological terms
• HF is defined as a syndrome
• characterized by elevated cardiac filling pressures and / or
• inadequate peripheral O2 delivery
• at rest or during stress caused by cardiac dysfunction
5. STAGE A STAGE B STAGE C STAGE D
AT RISK
HF
PRE HF SYMPTOMATIC
HF
ADVANCED
HF
Symptom + Sign of HF
Structural heart disease
Marked
Symptom + Sign of HF
Structural heart disease
Repeated Hospitalizations
6. HFrEF HFmrEF HFpEF
Symptoms + Signs Symptoms + Signs Symptoms + Signs
LV EF < 40% LV EF 41% - 49% LV EF > 50%
Objective evidence of
cardiac structural or
functional abnormality
including increase BNP
HF improved EF
(Treatment remains same as that of HFrEF)
9. HIGH OUTPUT STATES
AV Fistula
Chronic Anemia
Thyrotoxicosis
Beri Beri
OTHER FACTORS
Coronary Ischemia
Arrhythmias
Uncontrolled hypertension
Pulmonary embolism
Systemic infection/ sepsis
Patient related factors
Provider related factors
10. Na & Water
RETENTION
INCREASE PRELOAD
VASOCONSTRICTION
INCREASE AFTERLOAD
DECREASES MYOCARDIAL
CONTRACTILITY
DECREASES CARDIAC OUTPUT
12. Chronic HF describes those who have had an established
long-standing diagnosis of HF or who have a more gradual
onset of symptoms.
13. The diagnosis of CHF requires the presence of symptoms and/or signs of HF
and objective evidence of cardiac dysfunction
PRO
BNP
BNP
ECHO
Chronic Symptoms & signs
of HF
Risk factors for HF
Abnormal ECG/ CXR
Confirm Heart Failure
Define EF & Etiology
EF
Structure
> 125 pg/mL
> 35 pg/mL
14. Dyspnoea during exercise on less strenuous activity
ultimately may occur at rest
Paroxysmal nocturnal dyspnoea, Orthopnoea
Fatigue, Poor effort tolerance
Ankle edema
Nocturnal cough
Anorexia, nausea, early satiety, Rt upper quadrant
abdominal pain & fullness
Confusion, Disorientation, Oliguria
16. • AKI – Due to poor renal perfusion
• Impair liver function
• Hypokalemia, hyperkalemia
• Hyponatremia
• Thromboembolism
• Atrial or ventricular arrhythmias
• Sudden cardiac death
17. 12 lead ECG
CXR PA View
BNP/ NT Pro BNP test
ECHO
Test for Comorbidities Test for Etiology
CBC
Urea Creatinine
Electrolytes
Fasting Glucose, HBA1c
Lipid Profile
TSH
Iron status – Serum Iron, TIBC, Ferritin
High pretest probability of CAD –PCI
Intermediate probability of CAD Stress
ECHO, Exercise testing
Specific disease workup if required
Cardiac – MRI [Infiltrative disorders)
Endomyocardial biopsy
Rt Heart catheterization – done rarely in
evaluation for transplant
18. ECG – May by abnormal due to ACS, tachyarrhythmias, LBBB, Chamber enlargement
19.
20. BNP [ >35 pg/mL CHF] [ >100 pg/dLAHF ]
NT Pro BNP [ > 125 pg/mL CHF] [ >400 pg/dLAHF ]
Released from failing heart (sensitive marker for HF)
• Support diagnosis of HF
• Prognosis
• GDMT
• Falsely elevated in acute cardiac illness,
critical illness, Sepsis, PE, AKI
BIOMARKERS: Troponin T (Ischemia)
21. New diagnosis of HF
Clinical change in patient with known diagnosis of HF
Assess structure, chambers, Valves,
flow dynamics, function, EF
26. • Dyslipidemia, Hypertension, diabetes, obesity
Treat risk factors
• CABG/ PCI
CAD
• Anticoagulation, Digoxin
AF
• Assess and treat if required
Sleep Disorders
• IV Ferric Carboxy maltose
Iron deficiency
• Limited Exercise and weight reduction
• Low salt diet, Low fat diet, smoking cessation
Advise
• Influenza
• Pneumococcal
Vaccine
27. Reduce risk of SCD
LV EF < 35%
QRS WNL
Ischemic origin after 40 d
if survival is > 40 days
Post cardiac arrest
VT with hypotension
28. Reduce mortality and morbidity in selected patients and
improves cardiac function
LV EF < 35%
QRS wide with LBBB
Sinus rhythm
Symptomatic
HF patients
30. Acute HF is rapid onset of new or worsening of
preexisting HF requiring hospitalization.
31. PRO
BNP
BNP
ECHO
Acute Symptoms & signs
of HF
Risk factors for HF
Abnormal ECG/ CXR/
SpO2
Confirm Heart Failure
Define EF & Etiology
EF
Structure
> 400 pg/mL
> 100 pg/mL
The diagnosis of AHF requires the presence of Rapid onset of HF
or acute decompensation of existing HF
32. HIGH OUTPUT STATES
Chronic Anemia
Thyrotoxicosis
Beri Beri
OTHER FACTORS
Coronary Ischemia
Arrhythmias
Uncontrolled hypertension
Valvular heart disease
Pulmonary embolism
Systemic infection/ sepsis
Patient related factors
Provider related factors
33. • Volume overload
Acute Decompensation
(Typical)
• Volume overload
• Hypoperfusion with End organ dysfunction
Acute Decompensation
(Low Output)
• Severe Pulmonary congestion
• Hypoxia
Acute Pulmonary
Edema
• Hypotension with low cardiac output
• End Organ Failure
Cardiogenic Shock
35. 12 lead ECG
CXR PA View, SpO2, ABG
BNP/ NT Pro BNP test
ECHO
Test for Comorbidities Test for Etiology
CBC
Urea Creatinine
Electrolytes
Fasting Glucose, HBA1c
Lipid Profile
Evaluate – coexisting infections
TSH
Iron status – Serum Iron, TIBC, Ferritin
High pretest probability of CAD –PCI
SpO2 monitor
ABG
Swan Ganz Catheter
(Assess PA pressures)
In cardiogenic shock
36. O2, NIV, Ventilatory support
Congestion/ Fluid overload
• IV Loop Diuretics
• Increase dose - IV loop diuretic,
• Loop diuretic + metolazone
• Renal replacement therapy
Hypoperfusion
• Inotropes – Dobutamine, Dopamine (Milrinone, Levosimendan)
• Vasopressors - Norepinephrine
• Mechanical circulatory support, Emergency PCI
Vasodilators- IV Nitrates , IV Nitroprusside
Other drugs :IV opioids (in acute pulm edema), Anticoagulants (in AF)
37. DIURETICS
• Furosemide
• Continuous
• vs Bolus
Add on
• Chlorothiazide
or Metolazone
Refractory or in
Cardiorenal Syndrome
• RRT
Vasodilator Inotropes Vasopressor Other Rx
Nitroglycerine
Na
Nitroprusside
(Reserve drug)
Nesiritide
(Utilization waned)
Dobutamine
Dopamine
Milrinone, Levosimendan
(Utilization waned)
Norepinephrine ACS
Arrhythmia
Infection
Anemia
Switch to oral Rx
as for HFrEF
40. 69 years old Female
Dyspnoea on exertion - 3 month
Anorexia
Vital Stable
Pedal edema present
Pro BNP 544 pg/mL
ECHO – EF 40% , MR +
41. 65 years Male smoker, diabetes
Progressive dyspnoea 3 days and now dyspnoeic at rest 1 day.
Temp 100 F, Pallor
Pulse 104/min
RR 28/min, Spo2 90%
BP 122/80 mmHg
Warm peripheries
JVP raised
Pedal edema present
Tender hepatomegaly.
Pro BNP 544 pg/mL
ECHO – EF 25% , MR + RWMA +
Trop T positive
42. 52 years Male
Progressive dyspnoea 1 year associated with wheeze
On treatment with bronchodilators from Pvt Nursing home
reported to our hospital due to no improvement in symptoms.
Don’t mistake
cardiac asthma for
bronchial asthma
EXAMINE
PATIENT
HAD SIGNIFICANT MURMUR