SlideShare a Scribd company logo
Reversible Etiology
Reversible Heart Failure ,is it different ??
Dr Asadullah Khan Soomro & Dr Burai Adlan
Department of Adult Cardiology
King Abdullah Medical City Holy Makkah
Email; hssbasadsoomro@gmail.com
Non Dilated ,non ischemic
Heart Failure Syndromes
With Severe Systolic Dysfunction
“ Benign or Malignant”
Non Dilated ,Non Ischemic
De-Novo Heart Failure ,Severe LV Systolic
Dysfunction, moderate MR severe pulm hypertension
.
Journey of simple acute De-Novo
Heart Failure syndromes
Admitted 30.12 2019,discharged
2.1.2020, three post discharge HF face
to face visits.
Two HF Virtual Clinic review 23.6.20 and 19.8.20.
Later regular HF review .Last visit 6.4.2021.
IstPost discharge Heart Failure clinic Visit on 28.1.2021, Stopped Coversyl and after 36 hours wash out
switched to sacubitril 50 mg bid,
2nd Visit 11.2.2021 Clinically compensated, Vitally stable, Labs OK Sacubitril Titrated to 100 mg bid
3rd visit 10.3.20 No ER visit, No readmission, Vitally stable ,Labs OK sacubitril titrated to200 bid.
First HF
hospitalization
ER Visit Post discharge HF clinic
Transitional care
Vulnerable phase to visit
ER and readmission
BNP Level
6.2.20, 759
8.3.20, 1105
19.8.20, 179
20.10.20, 47
HB%, 14.3, Trop 0.070, HB A1C 8.4
Creat 1.0, Na 139, K,4.3 T bil,0.7
AST 15, ALT 26,Cholest 128,TG 80
LDL 75, HDL 37 ,Uric acid 9.3
Here we are at Get with the Guide Line standard
( AHA) Achieved sacubitril dose titration goal with
in 5-6 weeks . We wish could have even started
early before discharge from hospital.
Non Dilated ,Non Ischemic
De-Novo Heart Failure ,Severe LV Systolic
Dysfunction, moderate MR severe pulm hypertension
62 year male DM,HTN non smoker admitted first time at local
hospital in December 2019 with H/O symptoms of heart failure
FC 111 1V for two weeks
Diagnosed to had De-Novo heart failure with severe LV
systolic dysfunction EF 20-25%.No major organ dysfunction
After stablization shifted to our hospital on 30.12.2019 for CAG
to rule out CAD.
Echo revealed Non dilated LV with severe global systolic
dysfunction, & moderate MR
Non Dilated ,Non Ischemic
De-Novo Heart Failure ,Severe LV Systolic
Dysfunction, moderate MR severe pulm hypertension
Did CAG and coronaries were essentially normal, evaluated by MRP
and was considered for CRTD after cardiac MRI.
Seen by pulmonology colleague and there was no apparent cause of
severe pulmonary hypertension, may be related to heart failure.
Discharged on 3rd day on Perindopril, Bisoprolol, Spironolactone
,Furosemide, Nitrates ,Statins and ASA .
Follow up after two weaks at HF clinic /MRP 3 months.
Post discharge he was seen in screening clinic on 28.1.20
( First HF Review ).
Subsequently he was seen face to face until sacubitril full dose
titration, stopped Nitrates and furosemide ,Followed twice Virtually
,& Refilled 200 mg sacubitril .
Non Dilated ,Non Ischemic
De-Novo Heart Failure ,Severe LV Systolic
Dysfunction, moderate MR severe pulm hypertension
During COVID phase could not turn up for CMRI, neither got opportunity
to repeat echo after 6 months of sacubitril full dose ( standard
practice) .
BNP came down from 1105 to 47 , He maintained dry weight to 75 Kg,
Echo was repeated after one year of sacubitril 200 mg , His EF improved
from 20-25% to 50-55%, MR reduced to mild pulmonary
hypertension stablized RSVP reduced from > 60 to 35.
Last seen on 6.4.21 ,sacubitril changed to candesarten 16 mg
Will see him back after 4 months.
During this one & half year journey on ARNI, 0% Visit to ER,0% Non HF
and HF readmission, Improved quality of life .Fasted whole month of
Ramdan with prayers in Masjid.
( Be Ever green)
Non Dilated non Ischemic
Heart Failure
Improved EF ( 15 month Post ARNI )
.
30.12.2019 before ARNI
The left ventricle is grossly normal size.
EF= 20-25 %
There is moderate to severe global hypokinesis of
the left ventricle.
The right ventricle is mild to moderately dilated.
The right ventricular systolic function is mildly
reduced.
There is moderate mitral regurgitation. (vena
contracta = 0.4 cm) No Aortic Valve stenosis No
aortic regurgitation is present. There is moderate
to severe tricuspid regurgitation.
Right ventricular systolic pressure is elevated at
>60mmHg. (assuming RAP =15 mmHg)
There is no pericardial effusion.
4.4.2021 After ARNI
Left ventricular systolic function is low normal.
EF= 50-55 %
There is borderline global hypokinesis of the left
ventricle.
Left ventricular diastolic dysfunction grade II.
The right ventricle is normal in size and function.
The left atrium is mildly dilated.
There is mild mitral regurgitation.
Right ventricular systolic pressure is elevated at 30-
40mmHg.
There has been an improvement of the global LV
systolic function since the last echo 2019.
Soomro’s Classification of Heart Failure
Syndromes
.
Acute De-Novo
Heart Failure syndromes
Chronic Heart Failure
Syndromes
Chronic
Compensated
Stage C Acute
Decompensation
of Chronic HF
Stage C
Chronic
Advanced HF
Syndromes
Stage D
Acute
De-Novo
Simple Acute
De-Novo
Complex
Acute
De-Novo
Malignant
“Benign or Malignant ?”
We have following 6 common heart failure syndromes , always classify your patients
80 to 90% job is clinical . Use your wisdom before decisions.
Heart Failure clinic Dispose Criteria
“ Dispose to where ,if greens are rising“
Low risk HF patient ,can be discharged if established co-ordinated follow
up at community heart failure services are available at primary /
secondary care HF Clinics attended by combination of nurses and
experienced physicians. Minimum of at least two of the following patient
characteristics should be present to justify discharge from HF clinic.
1) Stable NYHA class 1 or 11 for 6-12 months.
2) Using optimal devices and pharmacological therapies.
3) Stable adherence to optimal HF therapy.
4) No hospitalization for > one year.
5) LVEF > 35% ( Consisitently shown if > 1 recent EF measurement).
6) Reversible causes of heart failure controlled.
7) Follow up by physician interested in management of HF.
8) Establish a new permanent KAMC Virtual Heart failure clinic
Alternatives after disposal
from HF clinic
Establish a Net work of
Community
Heart Failure
Services
Under supervision of
Makkah Heart Failure
cluster.
Establish
KAMC
Permanent Virtual Heart
Failure Clinic
Under umbrella of
Nurse led multi disciplinary
Heart Failure
Clinic
Reduce your burden of Heart Failure ER Visits and re admissions through these alternatives
Other wise, we can not break vicious cycle of disposal and re appearance as new cases,
will cost more ??
King Abdullah Medical City Holy Makkah
From the desk of Heart failure Clinic
“Feed back letter to referring hospital/community physician ”
Dear Doctors,
I had the pleasure of meeting your patient Mr./ Miss / Mrs.__________________________________ in Rapid Access Heart Failure clinic today. I
have reviewed the records that you have kindly forwarded to me, although you are familiar with patients history. I will briefly review it for your
record and ours.
Above named Patient is a _______ year old man/woman who gives thorough history including concomitant medical problems. A social history,
family, occupational history and current medications __________________
__________________________________________________________________________________________
He/she now complaining of
____________________________________________________________________________________________with past medical history of
_________________________________________________________ he/she does/ does not smoke or drink alcohol, he /she lives with
____________________________ and worked as _________ but unable to work for
________________________________________________________________________
Overall Patient is suffering from heart failure Stage ________________ due to an____________ ____________. Precipitated by
___________________ there is / is no evidence of fluid overload at this time. Other pertinent diagnosis and problems include,
____________________________________________________________________________________________
I would suggest the following further diagnostic tests to assess present status and prognosis. I have taken the liberty to adjust her current
medications as follows __________________________________________________
____________________________________________________________________________________________
I have also suggested the initiation of Beta blocks / ACE inhibitors / others _______________________________.
I have also introduced her to Dr. / Nurse _________________________ members of the team for follow-up care.
Once the above testing is completed and medications adjusted. I will plan on seeing him/her to discuss results and plans. At that time I will
communicate my findings to you.
I appreciate the opportunity to participate in patient care with you.
Sincerely,
Physician Name & Signature
Note ( Modify your description according to patient and type of clinic)
Summary
Heart Failure is a science and a art ,guide line are to guide
us ,but decision is your. Devices are revolutionary but at
the cost of complications especially infections.
Do not treat only ejection fraction, treat heart failure and
patient as a whole. Things keep changing beyond our
expectations .
Devices are life changing and saving indeed but
effectiveness of drugs and idiopathic dynamic etiology
must be considered and, review your patient from time to
time for devices.
Summary
HF clinic is a old and tiny part of multidisciplinary
heart failure programe.
Non Dilated non ischemic cardiomyopathy is new
entity in heart failure world ,especially idiopathic.
Improved HF & ejection fraction was because of drugs
or underlying idiopathic etiology is a mysterious
question ,credit goes to physician scientist or industry
?? 50-50% or 70-30% ? You are the best judge.
( Be Ever green)
Thanks to all colleagues for giving us opportunity to take care
of this Pleasant gentleman,& to learn some thing new in heart
failure world of tigers and elephants .

More Related Content

What's hot

Ischemic Heart Failure Classification
Ischemic Heart Failure ClassificationIschemic Heart Failure Classification
Ischemic Heart Failure Classification
asadsoomro1960
 
ABHM 15 healthy HF living tips
ABHM 15 healthy HF living tipsABHM 15 healthy HF living tips
ABHM 15 healthy HF living tips
asadsoomro1960
 
When Heart kills liver
When Heart kills liverWhen Heart kills liver
When Heart kills liver
asadsoomro1960
 
Part 1, MHFS,why to build MDHFP
Part 1, MHFS,why to build MDHFPPart 1, MHFS,why to build MDHFP
Part 1, MHFS,why to build MDHFP
asadsoomro1960
 
Device therapy in advanced HF.
Device therapy in advanced HF.Device therapy in advanced HF.
Device therapy in advanced HF.
asadsoomro1960
 
Heart failure inter_hospital_model_of_care_kamc_holy_makkah_document_from_asa...
Heart failure inter_hospital_model_of_care_kamc_holy_makkah_document_from_asa...Heart failure inter_hospital_model_of_care_kamc_holy_makkah_document_from_asa...
Heart failure inter_hospital_model_of_care_kamc_holy_makkah_document_from_asa...
asadsoomro1960
 
Ischemic heart failure benign or malignant
Ischemic heart failure   benign or malignantIschemic heart failure   benign or malignant
Ischemic heart failure benign or malignant
asadsoomro1960
 
Advanced heart failure september18
Advanced heart failure september18Advanced heart failure september18
Advanced heart failure september18
asadsoomro1960
 
Makkah HF registry oct 2021
Makkah HF registry oct 2021Makkah HF registry oct 2021
Makkah HF registry oct 2021
asadsoomro1960
 
Malignancy begets malignancy cases 1
Malignancy begets malignancy cases 1Malignancy begets malignancy cases 1
Malignancy begets malignancy cases 1
asadsoomro1960
 
Part 3, MHFS, how to build MDHFP
Part 3, MHFS, how to build MDHFPPart 3, MHFS, how to build MDHFP
Part 3, MHFS, how to build MDHFP
asadsoomro1960
 
Statin induced rhabdomyolytic syndrome
Statin induced rhabdomyolytic syndromeStatin induced rhabdomyolytic syndrome
Statin induced rhabdomyolytic syndrome
asadsoomro1960
 
Cardio-oncology chemotherapy induced cardiomyopathy cases no 2
Cardio-oncology chemotherapy induced cardiomyopathy cases no 2Cardio-oncology chemotherapy induced cardiomyopathy cases no 2
Cardio-oncology chemotherapy induced cardiomyopathy cases no 2
asadsoomro1960
 
Part 2 MHFS, how to build MDHFP
Part 2 MHFS, how to build MDHFPPart 2 MHFS, how to build MDHFP
Part 2 MHFS, how to build MDHFP
asadsoomro1960
 
Perioperative Heart Transplant Management and Complications by Dr. Aliessa Ba...
Perioperative Heart Transplant Management and Complications by Dr. Aliessa Ba...Perioperative Heart Transplant Management and Complications by Dr. Aliessa Ba...
Perioperative Heart Transplant Management and Complications by Dr. Aliessa Ba...
CMHRespiratoryCare
 
Network of novel HF clinics holy makkah
Network of novel HF clinics holy makkahNetwork of novel HF clinics holy makkah
Network of novel HF clinics holy makkah
asadsoomro1960
 
Heart transplantation
Heart transplantationHeart transplantation
Heart transplantation
Ramachandra Barik
 

What's hot (17)

Ischemic Heart Failure Classification
Ischemic Heart Failure ClassificationIschemic Heart Failure Classification
Ischemic Heart Failure Classification
 
ABHM 15 healthy HF living tips
ABHM 15 healthy HF living tipsABHM 15 healthy HF living tips
ABHM 15 healthy HF living tips
 
When Heart kills liver
When Heart kills liverWhen Heart kills liver
When Heart kills liver
 
Part 1, MHFS,why to build MDHFP
Part 1, MHFS,why to build MDHFPPart 1, MHFS,why to build MDHFP
Part 1, MHFS,why to build MDHFP
 
Device therapy in advanced HF.
Device therapy in advanced HF.Device therapy in advanced HF.
Device therapy in advanced HF.
 
Heart failure inter_hospital_model_of_care_kamc_holy_makkah_document_from_asa...
Heart failure inter_hospital_model_of_care_kamc_holy_makkah_document_from_asa...Heart failure inter_hospital_model_of_care_kamc_holy_makkah_document_from_asa...
Heart failure inter_hospital_model_of_care_kamc_holy_makkah_document_from_asa...
 
Ischemic heart failure benign or malignant
Ischemic heart failure   benign or malignantIschemic heart failure   benign or malignant
Ischemic heart failure benign or malignant
 
Advanced heart failure september18
Advanced heart failure september18Advanced heart failure september18
Advanced heart failure september18
 
Makkah HF registry oct 2021
Makkah HF registry oct 2021Makkah HF registry oct 2021
Makkah HF registry oct 2021
 
Malignancy begets malignancy cases 1
Malignancy begets malignancy cases 1Malignancy begets malignancy cases 1
Malignancy begets malignancy cases 1
 
Part 3, MHFS, how to build MDHFP
Part 3, MHFS, how to build MDHFPPart 3, MHFS, how to build MDHFP
Part 3, MHFS, how to build MDHFP
 
Statin induced rhabdomyolytic syndrome
Statin induced rhabdomyolytic syndromeStatin induced rhabdomyolytic syndrome
Statin induced rhabdomyolytic syndrome
 
Cardio-oncology chemotherapy induced cardiomyopathy cases no 2
Cardio-oncology chemotherapy induced cardiomyopathy cases no 2Cardio-oncology chemotherapy induced cardiomyopathy cases no 2
Cardio-oncology chemotherapy induced cardiomyopathy cases no 2
 
Part 2 MHFS, how to build MDHFP
Part 2 MHFS, how to build MDHFPPart 2 MHFS, how to build MDHFP
Part 2 MHFS, how to build MDHFP
 
Perioperative Heart Transplant Management and Complications by Dr. Aliessa Ba...
Perioperative Heart Transplant Management and Complications by Dr. Aliessa Ba...Perioperative Heart Transplant Management and Complications by Dr. Aliessa Ba...
Perioperative Heart Transplant Management and Complications by Dr. Aliessa Ba...
 
Network of novel HF clinics holy makkah
Network of novel HF clinics holy makkahNetwork of novel HF clinics holy makkah
Network of novel HF clinics holy makkah
 
Heart transplantation
Heart transplantationHeart transplantation
Heart transplantation
 

Similar to New toy in town,non dilated non ischemic HF

Heart failure strategy dec 18
Heart failure strategy dec 18Heart failure strategy dec 18
Heart failure strategy dec 18
asadsoomro1960
 
Million Heart, ticking time bomb can we predict or prevent
Million Heart, ticking time bomb can we predict or preventMillion Heart, ticking time bomb can we predict or prevent
Million Heart, ticking time bomb can we predict or prevent
asadsoomro1960
 
Chronic Coronary Syndrome ESC 2019.pptx
Chronic Coronary Syndrome ESC 2019.pptxChronic Coronary Syndrome ESC 2019.pptx
Chronic Coronary Syndrome ESC 2019.pptx
Mouhammad1
 
Heart failure - pathogenesis and current management
Heart failure - pathogenesis and current managementHeart failure - pathogenesis and current management
Heart failure - pathogenesis and current management
Subhasish Deb
 
A Mistake that has Hurt No One: Sinus Mistakus
A Mistake that has Hurt No One: Sinus MistakusA Mistake that has Hurt No One: Sinus Mistakus
A Mistake that has Hurt No One: Sinus Mistakus
asclepiuspdfs
 
2017 AHA ACC Hypertension Guidelines made simple
2017 AHA ACC Hypertension Guidelines made simple2017 AHA ACC Hypertension Guidelines made simple
2017 AHA ACC Hypertension Guidelines made simple
Mgfamiliar Net
 
Guidelines for Hypertension 2017
Guidelines for Hypertension 2017 Guidelines for Hypertension 2017
Guidelines for Hypertension 2017
Utai Sukviwatsirikul
 
Surgical solution for failing heart
Surgical solution for failing heartSurgical solution for failing heart
Surgical solution for failing heartHarilal Nambiar
 
15 tips to improve HF services in Pakistan.pptx
15 tips to improve HF services in Pakistan.pptx15 tips to improve HF services in Pakistan.pptx
15 tips to improve HF services in Pakistan.pptx
asadsoomro1960
 
Pharmacotherapy of Heart Failure.pptx
Pharmacotherapy of Heart Failure.pptxPharmacotherapy of Heart Failure.pptx
Pharmacotherapy of Heart Failure.pptx
jiregna5
 
Anticoagulant in surgery
Anticoagulant in surgeryAnticoagulant in surgery
Anticoagulant in surgery
Tenzin yoezer
 
Preop Evaluation
Preop EvaluationPreop Evaluation
Preop Evaluation
RedDevil52
 
Europe heart journal Advance July-2012
Europe heart journal Advance July-2012Europe heart journal Advance July-2012
Europe heart journal Advance July-2012
drucsamal
 
PPCM Case Report
PPCM Case ReportPPCM Case Report
PPCM Case Report
DeriArara1
 
Lab test 1.pptx
Lab test 1.pptxLab test 1.pptx
Lab test 1.pptx
ssuser70621f
 
Echocardiography .pptx
Echocardiography .pptxEchocardiography .pptx
Echocardiography .pptx
IshGarcia
 
HF classification
HF classificationHF classification
HF classification
asadsoomro1960
 
My Graphic Heart Failure classification.
My Graphic Heart Failure classification.My Graphic Heart Failure classification.
My Graphic Heart Failure classification.
asadsoomro1960
 
Pharmaceutical care plan
Pharmaceutical care planPharmaceutical care plan
Pharmaceutical care planNorliza Ariffin
 
PHYSIOTHERAPY IN HEART TRANSPLANTATION..
PHYSIOTHERAPY IN HEART TRANSPLANTATION..PHYSIOTHERAPY IN HEART TRANSPLANTATION..
PHYSIOTHERAPY IN HEART TRANSPLANTATION..
AneriPatwari
 

Similar to New toy in town,non dilated non ischemic HF (20)

Heart failure strategy dec 18
Heart failure strategy dec 18Heart failure strategy dec 18
Heart failure strategy dec 18
 
Million Heart, ticking time bomb can we predict or prevent
Million Heart, ticking time bomb can we predict or preventMillion Heart, ticking time bomb can we predict or prevent
Million Heart, ticking time bomb can we predict or prevent
 
Chronic Coronary Syndrome ESC 2019.pptx
Chronic Coronary Syndrome ESC 2019.pptxChronic Coronary Syndrome ESC 2019.pptx
Chronic Coronary Syndrome ESC 2019.pptx
 
Heart failure - pathogenesis and current management
Heart failure - pathogenesis and current managementHeart failure - pathogenesis and current management
Heart failure - pathogenesis and current management
 
A Mistake that has Hurt No One: Sinus Mistakus
A Mistake that has Hurt No One: Sinus MistakusA Mistake that has Hurt No One: Sinus Mistakus
A Mistake that has Hurt No One: Sinus Mistakus
 
2017 AHA ACC Hypertension Guidelines made simple
2017 AHA ACC Hypertension Guidelines made simple2017 AHA ACC Hypertension Guidelines made simple
2017 AHA ACC Hypertension Guidelines made simple
 
Guidelines for Hypertension 2017
Guidelines for Hypertension 2017 Guidelines for Hypertension 2017
Guidelines for Hypertension 2017
 
Surgical solution for failing heart
Surgical solution for failing heartSurgical solution for failing heart
Surgical solution for failing heart
 
15 tips to improve HF services in Pakistan.pptx
15 tips to improve HF services in Pakistan.pptx15 tips to improve HF services in Pakistan.pptx
15 tips to improve HF services in Pakistan.pptx
 
Pharmacotherapy of Heart Failure.pptx
Pharmacotherapy of Heart Failure.pptxPharmacotherapy of Heart Failure.pptx
Pharmacotherapy of Heart Failure.pptx
 
Anticoagulant in surgery
Anticoagulant in surgeryAnticoagulant in surgery
Anticoagulant in surgery
 
Preop Evaluation
Preop EvaluationPreop Evaluation
Preop Evaluation
 
Europe heart journal Advance July-2012
Europe heart journal Advance July-2012Europe heart journal Advance July-2012
Europe heart journal Advance July-2012
 
PPCM Case Report
PPCM Case ReportPPCM Case Report
PPCM Case Report
 
Lab test 1.pptx
Lab test 1.pptxLab test 1.pptx
Lab test 1.pptx
 
Echocardiography .pptx
Echocardiography .pptxEchocardiography .pptx
Echocardiography .pptx
 
HF classification
HF classificationHF classification
HF classification
 
My Graphic Heart Failure classification.
My Graphic Heart Failure classification.My Graphic Heart Failure classification.
My Graphic Heart Failure classification.
 
Pharmaceutical care plan
Pharmaceutical care planPharmaceutical care plan
Pharmaceutical care plan
 
PHYSIOTHERAPY IN HEART TRANSPLANTATION..
PHYSIOTHERAPY IN HEART TRANSPLANTATION..PHYSIOTHERAPY IN HEART TRANSPLANTATION..
PHYSIOTHERAPY IN HEART TRANSPLANTATION..
 

More from asadsoomro1960

ZA Bhutto Combind HF program updated.pptx
ZA Bhutto Combind HF program updated.pptxZA Bhutto Combind HF program updated.pptx
ZA Bhutto Combind HF program updated.pptx
asadsoomro1960
 
ZA Bhutto HF Program &networkpart III.pptx
ZA Bhutto HF Program &networkpart III.pptxZA Bhutto HF Program &networkpart III.pptx
ZA Bhutto HF Program &networkpart III.pptx
asadsoomro1960
 
ZA Bhutto HF program & network Part II.pptx
ZA Bhutto HF program & network Part II.pptxZA Bhutto HF program & network Part II.pptx
ZA Bhutto HF program & network Part II.pptx
asadsoomro1960
 
ZA Bhutto HF program & clinic network Part I.pptx
ZA Bhutto HF program & clinic network  Part I.pptxZA Bhutto HF program & clinic network  Part I.pptx
ZA Bhutto HF program & clinic network Part I.pptx
asadsoomro1960
 
ZA Bhutto Heart Failure Program part III.pdf
ZA Bhutto Heart Failure Program part III.pdfZA Bhutto Heart Failure Program part III.pdf
ZA Bhutto Heart Failure Program part III.pdf
asadsoomro1960
 
ZA Bhutto Heart Failure program Part II.pptx
ZA Bhutto Heart Failure program Part II.pptxZA Bhutto Heart Failure program Part II.pptx
ZA Bhutto Heart Failure program Part II.pptx
asadsoomro1960
 
ZA Bhutto Heart Failure program manual Part I.
ZA Bhutto Heart Failure program manual Part I.ZA Bhutto Heart Failure program manual Part I.
ZA Bhutto Heart Failure program manual Part I.
asadsoomro1960
 
Cancer & Heart. Cardio oncological syndromes
Cancer & Heart. Cardio oncological syndromesCancer & Heart. Cardio oncological syndromes
Cancer & Heart. Cardio oncological syndromes
asadsoomro1960
 
2 Tiger & one elephant HF .when Heart Kills liver.pptx
2 Tiger & one elephant HF .when Heart Kills liver.pptx2 Tiger & one elephant HF .when Heart Kills liver.pptx
2 Tiger & one elephant HF .when Heart Kills liver.pptx
asadsoomro1960
 
New Toy in Town,Non Dilated Non Ischemic HF.pptx
New Toy in Town,Non Dilated Non Ischemic HF.pptxNew Toy in Town,Non Dilated Non Ischemic HF.pptx
New Toy in Town,Non Dilated Non Ischemic HF.pptx
asadsoomro1960
 
Advanced Heart Failure syndromes .Benign or malignant
Advanced Heart Failure syndromes .Benign or malignantAdvanced Heart Failure syndromes .Benign or malignant
Advanced Heart Failure syndromes .Benign or malignant
asadsoomro1960
 
Heart Failure reasearch & physician scientist
Heart Failure reasearch & physician scientistHeart Failure reasearch & physician scientist
Heart Failure reasearch & physician scientist
asadsoomro1960
 
Acute cardiogenic Liver injury & Malignant heart failure Syndromes
Acute cardiogenic Liver injury & Malignant heart failure SyndromesAcute cardiogenic Liver injury & Malignant heart failure Syndromes
Acute cardiogenic Liver injury & Malignant heart failure Syndromes
asadsoomro1960
 
Healthy Heart failure awareness & selfcare zones .
Healthy Heart failure awareness & selfcare zones .Healthy Heart failure awareness & selfcare zones .
Healthy Heart failure awareness & selfcare zones .
asadsoomro1960
 
Summary of Hajj Book on cardiovascular Problems & Hajj.
Summary of  Hajj Book on cardiovascular Problems & Hajj.Summary of  Hajj Book on cardiovascular Problems & Hajj.
Summary of Hajj Book on cardiovascular Problems & Hajj.
asadsoomro1960
 
Vulnerable phases of Heart Failure syndromes
Vulnerable phases of Heart Failure syndromesVulnerable phases of Heart Failure syndromes
Vulnerable phases of Heart Failure syndromes
asadsoomro1960
 
Biography Dr Soomro. Altamash General Hospital Karachi
Biography   Dr Soomro. Altamash General Hospital KarachiBiography   Dr Soomro. Altamash General Hospital Karachi
Biography Dr Soomro. Altamash General Hospital Karachi
asadsoomro1960
 
Dr soomros 33 years HF journey ,unique experience
Dr soomros 33 years HF journey ,unique experienceDr soomros 33 years HF journey ,unique experience
Dr soomros 33 years HF journey ,unique experience
asadsoomro1960
 
Ischemic HF type IV
Ischemic HF type IV Ischemic HF type IV
Ischemic HF type IV
asadsoomro1960
 
New toy in town,non dilated non ischemic HF
New toy in town,non dilated non ischemic HFNew toy in town,non dilated non ischemic HF
New toy in town,non dilated non ischemic HF
asadsoomro1960
 

More from asadsoomro1960 (20)

ZA Bhutto Combind HF program updated.pptx
ZA Bhutto Combind HF program updated.pptxZA Bhutto Combind HF program updated.pptx
ZA Bhutto Combind HF program updated.pptx
 
ZA Bhutto HF Program &networkpart III.pptx
ZA Bhutto HF Program &networkpart III.pptxZA Bhutto HF Program &networkpart III.pptx
ZA Bhutto HF Program &networkpart III.pptx
 
ZA Bhutto HF program & network Part II.pptx
ZA Bhutto HF program & network Part II.pptxZA Bhutto HF program & network Part II.pptx
ZA Bhutto HF program & network Part II.pptx
 
ZA Bhutto HF program & clinic network Part I.pptx
ZA Bhutto HF program & clinic network  Part I.pptxZA Bhutto HF program & clinic network  Part I.pptx
ZA Bhutto HF program & clinic network Part I.pptx
 
ZA Bhutto Heart Failure Program part III.pdf
ZA Bhutto Heart Failure Program part III.pdfZA Bhutto Heart Failure Program part III.pdf
ZA Bhutto Heart Failure Program part III.pdf
 
ZA Bhutto Heart Failure program Part II.pptx
ZA Bhutto Heart Failure program Part II.pptxZA Bhutto Heart Failure program Part II.pptx
ZA Bhutto Heart Failure program Part II.pptx
 
ZA Bhutto Heart Failure program manual Part I.
ZA Bhutto Heart Failure program manual Part I.ZA Bhutto Heart Failure program manual Part I.
ZA Bhutto Heart Failure program manual Part I.
 
Cancer & Heart. Cardio oncological syndromes
Cancer & Heart. Cardio oncological syndromesCancer & Heart. Cardio oncological syndromes
Cancer & Heart. Cardio oncological syndromes
 
2 Tiger & one elephant HF .when Heart Kills liver.pptx
2 Tiger & one elephant HF .when Heart Kills liver.pptx2 Tiger & one elephant HF .when Heart Kills liver.pptx
2 Tiger & one elephant HF .when Heart Kills liver.pptx
 
New Toy in Town,Non Dilated Non Ischemic HF.pptx
New Toy in Town,Non Dilated Non Ischemic HF.pptxNew Toy in Town,Non Dilated Non Ischemic HF.pptx
New Toy in Town,Non Dilated Non Ischemic HF.pptx
 
Advanced Heart Failure syndromes .Benign or malignant
Advanced Heart Failure syndromes .Benign or malignantAdvanced Heart Failure syndromes .Benign or malignant
Advanced Heart Failure syndromes .Benign or malignant
 
Heart Failure reasearch & physician scientist
Heart Failure reasearch & physician scientistHeart Failure reasearch & physician scientist
Heart Failure reasearch & physician scientist
 
Acute cardiogenic Liver injury & Malignant heart failure Syndromes
Acute cardiogenic Liver injury & Malignant heart failure SyndromesAcute cardiogenic Liver injury & Malignant heart failure Syndromes
Acute cardiogenic Liver injury & Malignant heart failure Syndromes
 
Healthy Heart failure awareness & selfcare zones .
Healthy Heart failure awareness & selfcare zones .Healthy Heart failure awareness & selfcare zones .
Healthy Heart failure awareness & selfcare zones .
 
Summary of Hajj Book on cardiovascular Problems & Hajj.
Summary of  Hajj Book on cardiovascular Problems & Hajj.Summary of  Hajj Book on cardiovascular Problems & Hajj.
Summary of Hajj Book on cardiovascular Problems & Hajj.
 
Vulnerable phases of Heart Failure syndromes
Vulnerable phases of Heart Failure syndromesVulnerable phases of Heart Failure syndromes
Vulnerable phases of Heart Failure syndromes
 
Biography Dr Soomro. Altamash General Hospital Karachi
Biography   Dr Soomro. Altamash General Hospital KarachiBiography   Dr Soomro. Altamash General Hospital Karachi
Biography Dr Soomro. Altamash General Hospital Karachi
 
Dr soomros 33 years HF journey ,unique experience
Dr soomros 33 years HF journey ,unique experienceDr soomros 33 years HF journey ,unique experience
Dr soomros 33 years HF journey ,unique experience
 
Ischemic HF type IV
Ischemic HF type IV Ischemic HF type IV
Ischemic HF type IV
 
New toy in town,non dilated non ischemic HF
New toy in town,non dilated non ischemic HFNew toy in town,non dilated non ischemic HF
New toy in town,non dilated non ischemic HF
 

Recently uploaded

HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
GL Anaacs
 
POST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its managementPOST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its management
touseefaziz1
 
KDIGO 2024 guidelines for diabetologists
KDIGO 2024 guidelines for diabetologistsKDIGO 2024 guidelines for diabetologists
KDIGO 2024 guidelines for diabetologists
د.محمود نجيب
 
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdfBENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
DR SETH JOTHAM
 
basicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdfbasicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdf
aljamhori teaching hospital
 
Ocular injury ppt Upendra pal optometrist upums saifai etawah
Ocular injury  ppt  Upendra pal  optometrist upums saifai etawahOcular injury  ppt  Upendra pal  optometrist upums saifai etawah
Ocular injury ppt Upendra pal optometrist upums saifai etawah
pal078100
 
Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...
Sujoy Dasgupta
 
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdfAlcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
Dr Jeenal Mistry
 
NVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control programNVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control program
Sapna Thakur
 
Are There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdfAre There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdf
Little Cross Family Clinic
 
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
kevinkariuki227
 
heat stroke and heat exhaustion in children
heat stroke and heat exhaustion in childrenheat stroke and heat exhaustion in children
heat stroke and heat exhaustion in children
SumeraAhmad5
 
Non-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdfNon-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdf
MedicoseAcademics
 
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model SafeSurat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Savita Shen $i11
 
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdf
ARTIFICIAL INTELLIGENCE IN  HEALTHCARE.pdfARTIFICIAL INTELLIGENCE IN  HEALTHCARE.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdf
Anujkumaranit
 
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.GawadHemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
NephroTube - Dr.Gawad
 
Superficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptxSuperficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptx
Dr. Rabia Inam Gandapore
 
Ophthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE examOphthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE exam
KafrELShiekh University
 
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness JourneyTom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
greendigital
 
How to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for DoctorsHow to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for Doctors
LanceCatedral
 

Recently uploaded (20)

HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...
 
POST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its managementPOST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its management
 
KDIGO 2024 guidelines for diabetologists
KDIGO 2024 guidelines for diabetologistsKDIGO 2024 guidelines for diabetologists
KDIGO 2024 guidelines for diabetologists
 
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdfBENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
BENIGN PROSTATIC HYPERPLASIA.BPH. BPHpdf
 
basicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdfbasicmodesofventilation2022-220313203758.pdf
basicmodesofventilation2022-220313203758.pdf
 
Ocular injury ppt Upendra pal optometrist upums saifai etawah
Ocular injury  ppt  Upendra pal  optometrist upums saifai etawahOcular injury  ppt  Upendra pal  optometrist upums saifai etawah
Ocular injury ppt Upendra pal optometrist upums saifai etawah
 
Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...Couples presenting to the infertility clinic- Do they really have infertility...
Couples presenting to the infertility clinic- Do they really have infertility...
 
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdfAlcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
 
NVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control programNVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control program
 
Are There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdfAre There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdf
 
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...
 
heat stroke and heat exhaustion in children
heat stroke and heat exhaustion in childrenheat stroke and heat exhaustion in children
heat stroke and heat exhaustion in children
 
Non-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdfNon-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdf
 
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model SafeSurat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
Surat @ℂall @Girls ꧁❤8527049040❤꧂@ℂall @Girls Service Vip Top Model Safe
 
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdf
ARTIFICIAL INTELLIGENCE IN  HEALTHCARE.pdfARTIFICIAL INTELLIGENCE IN  HEALTHCARE.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdf
 
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.GawadHemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
 
Superficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptxSuperficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptx
 
Ophthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE examOphthalmology Clinical Tests for OSCE exam
Ophthalmology Clinical Tests for OSCE exam
 
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness JourneyTom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
 
How to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for DoctorsHow to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for Doctors
 

New toy in town,non dilated non ischemic HF

  • 1. Reversible Etiology Reversible Heart Failure ,is it different ?? Dr Asadullah Khan Soomro & Dr Burai Adlan Department of Adult Cardiology King Abdullah Medical City Holy Makkah Email; hssbasadsoomro@gmail.com Non Dilated ,non ischemic Heart Failure Syndromes With Severe Systolic Dysfunction “ Benign or Malignant”
  • 2. Non Dilated ,Non Ischemic De-Novo Heart Failure ,Severe LV Systolic Dysfunction, moderate MR severe pulm hypertension . Journey of simple acute De-Novo Heart Failure syndromes Admitted 30.12 2019,discharged 2.1.2020, three post discharge HF face to face visits. Two HF Virtual Clinic review 23.6.20 and 19.8.20. Later regular HF review .Last visit 6.4.2021. IstPost discharge Heart Failure clinic Visit on 28.1.2021, Stopped Coversyl and after 36 hours wash out switched to sacubitril 50 mg bid, 2nd Visit 11.2.2021 Clinically compensated, Vitally stable, Labs OK Sacubitril Titrated to 100 mg bid 3rd visit 10.3.20 No ER visit, No readmission, Vitally stable ,Labs OK sacubitril titrated to200 bid. First HF hospitalization ER Visit Post discharge HF clinic Transitional care Vulnerable phase to visit ER and readmission BNP Level 6.2.20, 759 8.3.20, 1105 19.8.20, 179 20.10.20, 47 HB%, 14.3, Trop 0.070, HB A1C 8.4 Creat 1.0, Na 139, K,4.3 T bil,0.7 AST 15, ALT 26,Cholest 128,TG 80 LDL 75, HDL 37 ,Uric acid 9.3 Here we are at Get with the Guide Line standard ( AHA) Achieved sacubitril dose titration goal with in 5-6 weeks . We wish could have even started early before discharge from hospital.
  • 3. Non Dilated ,Non Ischemic De-Novo Heart Failure ,Severe LV Systolic Dysfunction, moderate MR severe pulm hypertension 62 year male DM,HTN non smoker admitted first time at local hospital in December 2019 with H/O symptoms of heart failure FC 111 1V for two weeks Diagnosed to had De-Novo heart failure with severe LV systolic dysfunction EF 20-25%.No major organ dysfunction After stablization shifted to our hospital on 30.12.2019 for CAG to rule out CAD. Echo revealed Non dilated LV with severe global systolic dysfunction, & moderate MR
  • 4. Non Dilated ,Non Ischemic De-Novo Heart Failure ,Severe LV Systolic Dysfunction, moderate MR severe pulm hypertension Did CAG and coronaries were essentially normal, evaluated by MRP and was considered for CRTD after cardiac MRI. Seen by pulmonology colleague and there was no apparent cause of severe pulmonary hypertension, may be related to heart failure. Discharged on 3rd day on Perindopril, Bisoprolol, Spironolactone ,Furosemide, Nitrates ,Statins and ASA . Follow up after two weaks at HF clinic /MRP 3 months. Post discharge he was seen in screening clinic on 28.1.20 ( First HF Review ). Subsequently he was seen face to face until sacubitril full dose titration, stopped Nitrates and furosemide ,Followed twice Virtually ,& Refilled 200 mg sacubitril .
  • 5. Non Dilated ,Non Ischemic De-Novo Heart Failure ,Severe LV Systolic Dysfunction, moderate MR severe pulm hypertension During COVID phase could not turn up for CMRI, neither got opportunity to repeat echo after 6 months of sacubitril full dose ( standard practice) . BNP came down from 1105 to 47 , He maintained dry weight to 75 Kg, Echo was repeated after one year of sacubitril 200 mg , His EF improved from 20-25% to 50-55%, MR reduced to mild pulmonary hypertension stablized RSVP reduced from > 60 to 35. Last seen on 6.4.21 ,sacubitril changed to candesarten 16 mg Will see him back after 4 months. During this one & half year journey on ARNI, 0% Visit to ER,0% Non HF and HF readmission, Improved quality of life .Fasted whole month of Ramdan with prayers in Masjid. ( Be Ever green)
  • 6. Non Dilated non Ischemic Heart Failure Improved EF ( 15 month Post ARNI ) . 30.12.2019 before ARNI The left ventricle is grossly normal size. EF= 20-25 % There is moderate to severe global hypokinesis of the left ventricle. The right ventricle is mild to moderately dilated. The right ventricular systolic function is mildly reduced. There is moderate mitral regurgitation. (vena contracta = 0.4 cm) No Aortic Valve stenosis No aortic regurgitation is present. There is moderate to severe tricuspid regurgitation. Right ventricular systolic pressure is elevated at >60mmHg. (assuming RAP =15 mmHg) There is no pericardial effusion. 4.4.2021 After ARNI Left ventricular systolic function is low normal. EF= 50-55 % There is borderline global hypokinesis of the left ventricle. Left ventricular diastolic dysfunction grade II. The right ventricle is normal in size and function. The left atrium is mildly dilated. There is mild mitral regurgitation. Right ventricular systolic pressure is elevated at 30- 40mmHg. There has been an improvement of the global LV systolic function since the last echo 2019.
  • 7. Soomro’s Classification of Heart Failure Syndromes . Acute De-Novo Heart Failure syndromes Chronic Heart Failure Syndromes Chronic Compensated Stage C Acute Decompensation of Chronic HF Stage C Chronic Advanced HF Syndromes Stage D Acute De-Novo Simple Acute De-Novo Complex Acute De-Novo Malignant “Benign or Malignant ?” We have following 6 common heart failure syndromes , always classify your patients 80 to 90% job is clinical . Use your wisdom before decisions.
  • 8. Heart Failure clinic Dispose Criteria “ Dispose to where ,if greens are rising“ Low risk HF patient ,can be discharged if established co-ordinated follow up at community heart failure services are available at primary / secondary care HF Clinics attended by combination of nurses and experienced physicians. Minimum of at least two of the following patient characteristics should be present to justify discharge from HF clinic. 1) Stable NYHA class 1 or 11 for 6-12 months. 2) Using optimal devices and pharmacological therapies. 3) Stable adherence to optimal HF therapy. 4) No hospitalization for > one year. 5) LVEF > 35% ( Consisitently shown if > 1 recent EF measurement). 6) Reversible causes of heart failure controlled. 7) Follow up by physician interested in management of HF. 8) Establish a new permanent KAMC Virtual Heart failure clinic
  • 9. Alternatives after disposal from HF clinic Establish a Net work of Community Heart Failure Services Under supervision of Makkah Heart Failure cluster. Establish KAMC Permanent Virtual Heart Failure Clinic Under umbrella of Nurse led multi disciplinary Heart Failure Clinic Reduce your burden of Heart Failure ER Visits and re admissions through these alternatives Other wise, we can not break vicious cycle of disposal and re appearance as new cases, will cost more ??
  • 10. King Abdullah Medical City Holy Makkah From the desk of Heart failure Clinic “Feed back letter to referring hospital/community physician ” Dear Doctors, I had the pleasure of meeting your patient Mr./ Miss / Mrs.__________________________________ in Rapid Access Heart Failure clinic today. I have reviewed the records that you have kindly forwarded to me, although you are familiar with patients history. I will briefly review it for your record and ours. Above named Patient is a _______ year old man/woman who gives thorough history including concomitant medical problems. A social history, family, occupational history and current medications __________________ __________________________________________________________________________________________ He/she now complaining of ____________________________________________________________________________________________with past medical history of _________________________________________________________ he/she does/ does not smoke or drink alcohol, he /she lives with ____________________________ and worked as _________ but unable to work for ________________________________________________________________________ Overall Patient is suffering from heart failure Stage ________________ due to an____________ ____________. Precipitated by ___________________ there is / is no evidence of fluid overload at this time. Other pertinent diagnosis and problems include, ____________________________________________________________________________________________ I would suggest the following further diagnostic tests to assess present status and prognosis. I have taken the liberty to adjust her current medications as follows __________________________________________________ ____________________________________________________________________________________________ I have also suggested the initiation of Beta blocks / ACE inhibitors / others _______________________________. I have also introduced her to Dr. / Nurse _________________________ members of the team for follow-up care. Once the above testing is completed and medications adjusted. I will plan on seeing him/her to discuss results and plans. At that time I will communicate my findings to you. I appreciate the opportunity to participate in patient care with you. Sincerely, Physician Name & Signature Note ( Modify your description according to patient and type of clinic)
  • 11. Summary Heart Failure is a science and a art ,guide line are to guide us ,but decision is your. Devices are revolutionary but at the cost of complications especially infections. Do not treat only ejection fraction, treat heart failure and patient as a whole. Things keep changing beyond our expectations . Devices are life changing and saving indeed but effectiveness of drugs and idiopathic dynamic etiology must be considered and, review your patient from time to time for devices.
  • 12. Summary HF clinic is a old and tiny part of multidisciplinary heart failure programe. Non Dilated non ischemic cardiomyopathy is new entity in heart failure world ,especially idiopathic. Improved HF & ejection fraction was because of drugs or underlying idiopathic etiology is a mysterious question ,credit goes to physician scientist or industry ?? 50-50% or 70-30% ? You are the best judge. ( Be Ever green)
  • 13. Thanks to all colleagues for giving us opportunity to take care of this Pleasant gentleman,& to learn some thing new in heart failure world of tigers and elephants .