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Heart Failure

Heart Failure

Heart failure (HF) is a complex disorder whereby the heart becomes progressively unable to pump blood efficiently to the tissues of the body. The Heart Failure Knowledge Centre focuses on the pathophysiology, diagnosis and management of chronic and post myocardial infarction (post-MI) heart failure.

Risk factors for ACS, and subsequently post-MI heart failure, are usually the clinical consequence of the formation of an occlusive thrombus at the site of a ruptured or eroded atherosclerotic plaque in a coronary artery. These can be modifiable (smoking,1 obesity,1 lack of exercise,1 hypertension,1,2 hyperlipidaemia,2,3 diabetes mellitus3) and non-modifiable (increased age1, male gender1, family history1,2) risk-factors.

The Heart Failure Knowledge Centre aims to provides healthcare professionals with the tools to diagnose and manage patients with both chronic and post-MI heart failure in line with current ESC guidelines.


References

  1. Kumar P, Clark M. Clinical medicine. 7th ed. Edinburgh: Saunders Elsevier, 2009.
  2. Graham I, Atar D, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Eur J Cardiovasc Prevent Rehab 2007;14 Suppl. 2:E1-40.
  3. Zeljko Reiner, Alberico L. Catapano, Guy De Backer et al. ESC/EAS Guidelines for the management of dyslipidaemias: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J first published online June 28, 2011 doi:10.1093/eurheartj/ehr158.

Clinical Case Studies

Vascular Graft Infection

Infection: Cardiovascular Infections

Stephanie J. Dancer BSc, MB BS, MSc, MD, FRCPath, DTM&H, Consultant Microbiologist, NHS Lanarkshire, Scotland

Case History
A 72-year-old man was referred by his general practitioner complaining of intermittent pain in the legs on exercise.

MRSA Endocarditis

Infection: Cardiovascular Infections

Christopher D. Pfeiffer, Clinical Fellow, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
Vance Fowler, Associate Professor and Infectious Diseases, Specialist, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA

Case History
A 64-year-old female presented with three weeks of progressive dyspnoea, nausea and vomiting.

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Recent Drug Updates

Medical Journal Abstracts on Angiology

Efficacy of Dabigatran for Dissolving Deep Vein Thromboses in Outpatients With a Deteriorated General Condition.

Mon 13 Jul 2015 -  Efficacy of Dabigatran for Dissolving Deep Vein Thromboses in Outpatients With a Deteriorated General Condition.

Non-vitamin K antagonist oral anticoagulants (NOACs) have been widely used for the prevention of ischemic strokes in patients with nonvalvular atrial fibrillation (AF). At present, NOACs have been ...

Lack of "obesity paradox" in patients presenting with ST-segment elevation myocardial infarction including cardiogenic shock: a multicenter German network registry analysis.

Sat 11 Jul 2015 -  Lack of "obesity paradox" in patients presenting with ST-segment elevation myocardial infarction including cardiogenic shock: a multicenter German network registry analysis.

BACKGROUND: Studies have associated obesity with better outcomes in comparison to non-obese patients after elective and emergency coronary revascularization. However, these findings might have been ...

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Clinical Guidelines

European Stroke Organisation (ESO) guidelines for the management of temperature in patients with acute ischemic stroke

Jul 2015

Hyperthermia is a frequent complication in up to 50% of patients with acute ischemic stroke, and it..

... was shown to be associated with a poor outcome. On the other end, therapeutically induced hypothermia has shown promising potential in patients with hypoxic encephalopathy and in animal models of focal cerebral ischemia. This document presents the ESO guidelines on temperature management in patients with acute ischemic stroke. The aim of this Guideline document is to assist physicians treating patients with acute ischemic stroke in their clinical decisions with regard to the management of temperature.

Familial hypercholesterolaemia in children and adolescents: gaining decades of life by optimizing detection and treatment

May 2015

Familial hypercholesterolaemia (FH) is a common genetic cause of premature coronary heart disease..

... (CHD). Globally, one baby is born with FH every minute. If diagnosed and treated early in childhood, individuals with FH can have normal life expectancy. This consensus paper aims to improve awareness of the need for early detection and management of FH children. Familial hypercholesterolaemia is diagnosed either on phenotypic criteria, i.e. an elevated low-density lipoprotein cholesterol (LDL-C) level plus a family history of elevated LDL-C, premature coronary artery disease and/or genetic diagnosis, or positive genetic testing. Childhood is the optimal period for discrimination between FH and non-FH using LDL-C screening. An LDL-C ≥5 mmol/L (190 mg/dL), or an LDL-C ≥4 mmol/L (160 mg/dL) with family history of premature CHD and/or high baseline cholesterol in one parent, make the phenotypic diagnosis. If a parent has a genetic defect, the LDL-C cut-off for the child is ≥3.5 mmol/L (130 mg/dL). We recommend cascade screening of families using a combined phenotypic and genotypic strategy. In children, testing is recommended from age 5 years, or earlier if homozygous FH is suspected. A healthy lifestyle and statin treatment (from age 8 to 10 years) are the cornerstones of management of heterozygous FH. Target LDL-C is <3.5 mmol/L (130 mg/dL) if >10 years, or ideally 50% reduction from baseline if 8–10 years, especially with very high LDL-C, elevated lipoprotein(a), a family history of premature CHD or other cardiovascular risk factors, balanced against the long-term risk of treatment side effects. Identifying FH early and optimally lowering LDL-C over the lifespan reduces cumulative LDL-C burden and offers health and socioeconomic benefits. To drive policy change for timely detection and management, we call for further studies in the young. Increased awareness, early identification, and optimal treatment from childhood are critical to adding decades of healthy life for children and adolescents with FH.

Online CME

Bradycardia: diagnostic picture tests

After completing this module you should be able to: describe the classification of bradycardias, describe the common causes of different types of bradycardia, and recognise typical electrocardiograms (ECGs).

Peripheral arterial disease: an update on management

On completion of this module you should know: The incidence and prevalence of peripheral arterial disease. How best to treat it. What information to give to patients about prognosis.

Stroke prevention in atrial fibrillation

On completion of this module you will understand more about: risk factors and screening, calculating risk, anticoagulation and falls and therapy.

Clinical Trials

DIAMOND - Dual Antiplatelet Therapy to Reduce Myocardial Injury

Sun 01 Mar 2015

Heart attacks are most commonly caused by rupture of fatty deposits (plaques) within the wall of heart blood vessels. It appears that this process can also frequently occur without causing any ...

Rivaroxaban Versus Aspirin in Secondary Prevention of Stroke and Prevention of Systemic Embolism in Patients With Recent Embolic Stroke of Undetermined Source (ESUS) (NAVIGATE ESUS)

Mon 01 Dec 2014

This is a study in patients who recently had a brain attack (stroke) and in whom no clear cause of the stroke could be identified. These strokes are likely due to a blood clot and therefore, can be ...

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