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Heart Failure Update

Heart Failure Update

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Heart Failure Update

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  1. Heart Failure Update

  2. "The new season will be all about scoring more goals than the opposition” Alvin Martin

  3. "You can't do better than go away from home and get a draw."Kevin Keegan

  4. NICE 2010 • 1.1 Definition of chronic heart failure Heart failure is a complex clinical syndrome of symptoms and signs that suggest impairment of the heart as a pump supporting physiological circulation. It is caused by structural or functional abnormalities of the heart. The demonstration of objective evidence of these cardiac abnormalities is necessary for the diagnosis of heart failure to be made

  5. Right heart Failure – e.g. secondary to chronic lung disease High output heart failure Heart failure secondary to valvular heart disease Heart failure due to left ventricular disease

  6. Chronic Heart Failure Jessup M, Brozena S. N Engl J Med 2003;348:2007-2018.

  7. Angiotensinogen Sympathetic activation Renin Angiotensin I Angiotensin II Aldosterone Tachycardia vasoconstriction Spiro Salt retention

  8. "Julian Dicks is everywhere. It's like they've got eleven Dicks on the field” Radio commentator

  9. NICE Guidance Diagnostic Role of BNP

  10. NICE Guidance Treatment of heart failure due to left ventricular systolic dysfunction

  11. "Anyone who takes drugs should be hammered."Andy Gray

  12. Angiotensinogen Sympathetic activation Renin Angiotensin I ACEI Angiotensin II Beta B’s ARB Aldosterone vasoconstriction Tachycardia Spiro Salt retention

  13. John J.V. McMurray, M.D. N Engl J Med 2010; 362:228-238

  14. John J.V. McMurray, M.D. N Engl J Med 2010; 362:228-238

  15. "Gary always weighed up his options, especially when he had no choice” Kevin Keegan

  16. John J.V. McMurray, M.D. N Engl J Med 2010; 362:228-238

  17. NICE GuidanceTreatment of heart failure due to left ventricular systolic dysfunction

  18. National Heart Failure Audit

  19. What disappointed me was that we didn't play with any passion. I'm not disappointed, you know, I'm just disappointed."Kevin Keegan

  20. NICE Guidance – beta blockers

  21. β-Blockers May Reduce Mortality and Risk of Exacerbations in Patients With Chronic Obstructive Pulmonary Disease Rutten F.H et al Arch Intern Med. 2010;170(10):880-887.

  22. Ivabradine

  23. Diuretics

  24. "He dribbles a lot and the opposition don't like it - you can see it all over their faces” Ron Atkinson

  25. John J.V. McMurray, M.D. N Engl J Med 2010; 362:228-238

  26. Heart Failure with Preserved Ejection Fraction (HFPEF) Heart failure due to diastolic dysfunction No agreed cut off point for preserved EF

  27. "He reminds me of a completely different version of Robbie Earle."Mark Lawrenson

  28. Echocardiographic diagnosis abnormal normal

  29. Heart Failure Preserved Ejection Fraction

  30. Management of HFPEF • Control oedema • Rate control • Manage atrial fibrillation • Control Hypertension • Manage ischaemia

  31. "In some ways, cramp is worse than having a broken leg."Kevin Keegan

  32. Cardio renal syndrome • Reduced renal perfusion • Raised venous (intra-abdominal) pressure

  33. Adverse effects of HF treatment Diuretic induced volume depletion Vasodilator induced hypotension

  34. Effect of renal impairment on drug clearance Diuretic resistance ACEI / ARB Aldosterone antagonists Beta blockers

  35. ACEI & ARBs reduce efferent vasoconstriction and hence reduce GFR Afferent arteriole Efferent arteriole Angiotensin

  36. "Footballers are no different from human beings."Graham Taylor

  37. Resynchronisation