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Heart Failure (HF) : Overview. Common underlying heart diseases or causes of HF Valvular HD-Rheumatic etiology Cardiomyopathy – Dilated type Ischemic HD – Postmyocardial infarction. Epidemological Data of HF in USA.

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heart failure hf overview

Heart Failure (HF) : Overview

Common underlying heart diseases or causes of HF

Valvular HD-Rheumatic etiology

Cardiomyopathy – Dilated type

Ischemic HD – Postmyocardial infarction

epidemological data of hf in usa
Epidemological Data of HF in USA
  • 7.5 millions Americans have history of myocardialinfarction, 34% develope disable HF over 6 years
  • 500,000 patients were diagnosed as new HF cases every year
  • Major cause of HF is postmyocardial infarction cases
death in postmyocardial infarction
Death in Postmyocardial infarction
  • Cardiac sudden death-fatal ventricular arrhythmia (HR 4-6)
  • Progressive LV remodeling and failure to Pump failure
current managements of hf
Current managementsof HF
  • Diuretics

Inotropes and digitalis

Symptomatic relief but No mortality benefit

slide5
B. Evidences of improved morbidity (hemodynamic) and mortalityB.1 Drugs : ACEIBeta Blockers : Carvedilol Metoprolol, BisoprololAldosterone antagonist (RALES study, FC III-IV): spironodactone
slide6
B.2 Devices : ICD

Cardiac resynchronised

therapy (CRT) – Biventricular

pacings (COMPANION study)

C. Heart transplant : LVAD bridge

to transplant

slide7
Future Directions or New Paradigm in Management HF
  • Loop diuretic (Lasix) caused myocardial fibrosis (Lopez et all : JACC 2004; 43:2028-35)

Looking for new (type) diuretic

2. Beta Blockers : What type, How and When

to start

Carvedilol, metoprolol, Bisoprolol

slide8
3. The best order of initiating therapy :

ACEI-first VS Beta blocker-first

Bata blocker-first is superior (CIBIS-III,

Sliwa et all : JACC 2004;44:1825-30)

4. New selective aldosterone receptor

antagonist

From Spironolactone to Eplerenone

(EPHESUS study)

slide9
5. LVAD bridge to recovery (Sir Magdi Yacoub)

LVAD LV rest to reverseremodeling of LV (with Digoxin, ACEI, Beta blocker, Spironolactone)

Residual myocardial atrophyPhysilogic myocardialhypertrophy (by Beta agonist, Clenbuterol)

Recovered LV functionRemoved LVAD

Pilot study : 19 LVAD patients, 11 improved LV function and had LVAD removed

slide10
6. Cell (Stem Cell) Transplantation

Aims : - Growing of new cardiac

myocytes on scar tissue

- Stimulating angiogenesis to

viable and ischemic myocardium

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