case presentations in heart failure
play

Case Presentations in Heart Failure Ivor L Gerber Cardiologist Auckland Heart Group Auckland City Hospital Case 1 82 year old woman Longstanding hypertension Treatment for UTI Otherwise well Increasing shortness of breath Leg swelling

0 downloads 7 Views 753 KB Size Report
  1. Case Presentations in Heart Failure Ivor L Gerber Cardiologist Auckland Heart Group Auckland City Hospital

  2. Case 1 82 year old woman Longstanding hypertension Treatment for UTI Otherwise well Increasing shortness of breath Leg swelling Palpitations

  3. Clinical exam  Irregular rhythm, 110bpm  BP 160/90mmHg  Mild pitting oedema. No murmur. JVP +4cm. Bibasal crackles ECG  Atrial fibrillation, LVH. Troponin  Normal N-BNP  120 CXR  Mild cardiomegaly  Mild interstitial oedema

  4. Diagnosis – “ Heart failure ”

  5. Diagnosis – “ Heart failure ”  Clinical assessment  Supported by investigations so far

  6. What is the likely cause?  Common things occur commonly Hypertension  LVH, LV diastolic dysfunction, left atrial dilatation. Coronary artery disease  LV systolic / diastolic dysfunction Valve disease  LV systolic / diastolic impairment.  Precipitating factors Recent UTI Atrial fibrillation Check thyroid function

  7. What additional investigation(s) are needed? Echocardiogram  LV size and systolic function - often normal LVEF  LVH. LV diastolic function.  LA size  Valves  Right heart

  8. What additional investigation(s) are needed? Echocardiogram  LV size and systolic function - often normal LVEF  LVH. LV diastolic function.  LA size  Valves  Right heart 24 hour holter monitor  After rate control Exercise test  Consider after acute factors managed

  9. Treatment  General Diuresis Rate control of the atrial fibrillation Ensure the UTI is controlled Optimise blood pressure  Specific Depend on other results Rate vs rhythm control (LA size) Possible coronary artery disease

  10. Case 2 24 year old man No past history of note Physical job Non-smoker Minimal alcohol Tires easily, short of breath on exertion

  11. Clinical exam  Regular rhythm 110bpm  BP 95/60 mmHg  Multiple murmurs  No pitting oedema. JVP angle of jaw. Clear chest ECG  Sinus tachycardia, LVH N-BNP  1120 CXR  Moderate cardiomegaly  Pulmonary oedema

  12. Diagnosis  Heart failure What is the likely cause?  Common things occur commonly Valve disease – LV and/or RV impairment. Hypertension – LV diastolic dysfunction +/- atrial fibrillation Coronary artery disease – LV systolic/diastolic dysfunction What additional investigation(s) are needed? Echocardiogram Treatment General Specific

  13. Treatment  General Diuresis ACE inhibitor / ARB Beta blocker  Specific Valve replacement

  14. Heart Failure The diagnosis heralds the beginning, not the end, of the medical journey Clinical diagnosis supported by investigations Specific management depending on the cause High mortality, especially if not assessed and managed properly

  15. Diagnosis  “ Heart failure ” What is the likely cause?  Always consider underlying cause and precipitating factors What investigation(s) are needed?  Confirm diagnosis  Mechanism – guides management  Determine severity / prognosis Treatment

Recommend Documents


palliative care
PALLIATIVE CARE Advanced heart failure

PALLIATIVE CARE Advanced heart failure Heart failure has a poor prognosis

health failure telehealth final report
Health Failure Telehealth Final Report

Health Failure Telehealth Final Report Sarah Briggs Heart Failure Specialist

heart failure
HEART FAILURE S Y M P T O M S A N D

ACUTE DECOMPENSATING HEART FAILURE S Y M P T O M S A N D T R E A T M E N T

heart failure with preserved ejection fraction
Heart Failure with Preserved Ejection

Heart Failure with Preserved Ejection Fraction Advances in Heart Failure CME

outline chronic heart failure
Outline Chronic Heart Failure:

Outline Chronic Heart Failure: Diagnosis and Staging Update on Effective

management of co morbidities in heart failure copd renal
Management of Co- morbidities in Heart

Management of Co- morbidities in Heart Failure (COPD, Renal failure, Anemia)

outline chronic heart failure
Outline Chronic Heart Failure:

Outline Chronic Heart Failure: Diagnosis and Staging Effective Diagnosis,

active diuretic management to improve heart failure
Active Diuretic Management to Improve

Active Diuretic Management to Improve Heart Failure Outcomes Heart Failure

prevention of worsening heart failure
Prevention of Worsening Heart Failure

Prevention of Worsening Heart Failure by Serelaxin in Patients Admitted for

global heart failure awareness programme
Global Heart Failure Awareness

Global Heart Failure Awareness Programme Objective: To make prevention and

advanced heart failure medical management old and new
Advanced heart failure: Medical

Advanced heart failure: Medical management - old and new John McMurray BHF

urinary antihypertensive drug metabolite screening using
Urinary antihypertensive drug

Urinary antihypertensive drug metabolite screening using molecular networking

kol day presentation
KOL DAY PRESENTATION June 27 th , 2017

KOL DAY PRESENTATION June 27 th , 2017 FOCUS ON QUANTUM GENOMICS Disclaimer

a patient with chest pain
A Patient with Chest Pain and Atrial

A Patient with Chest Pain and Atrial Fibrillation ACCA Masterclass 2017 Kurt

incident lupus nephritis predictive and protective factors
Incident Lupus Nephritis. Predictive

Incident Lupus Nephritis. Predictive and Protective Factors Ana-Maria Orbai,

pharmacotherapy in chronic heart failure pharmacotherapy
Pharmacotherapy in Chronic Heart

Pharmacotherapy in Chronic Heart Failure: Pharmacotherapy in Chronic Heart

reconciliation workshop
Reconciliation Workshop Prepared by

Medication Reconciliation Workshop Prepared by the Saskatchewan Health

drugs to treat type 2 dm demonstrate reductions in major
Drugs to Treat Type 2 DM Demonstrate

Drugs to Treat Type 2 DM Demonstrate Reductions in Major Adverse

health and retirement a
Health and retirement: a Public Health

Health and retirement: a Public Health perspective Walter Ricciardi

management of blood pressure what are the new standards
Management of Blood Pressure What are

Asian Chapter Asian Chapter Management of Blood Pressure What are the new

detailed preliminary results of
Detailed Preliminary Results of

T S X : R V X Detailed Preliminary Results of BETonMACE Strengthening

covid 19
COVID 19 what is it all about ?

COVID 19 what is it all about ? CORONA VIRUS ELECTRON MICROSCOPE VIRUS