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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.

Type 2 Diabetes Knowledge Centre

Type 2 Diabetes Knowledge Centre

The leading cause of morbidity and mortality among patients with Type 2 diabetes mellitus is cardiovascular complications, with cardiovascular disease risk being 2- to 8-fold higher in the population than it is in non-diabetic individuals of a similar age, sex and ethnicity.1,2

Macrovascular complications (including coronary artery disease, peripheral arterial disease and stroke) and microvascular complications (including diabetic nephropathy, peripheral neuropathy and diabetic retinopathy), are collectively known as diabetic vascular complications that commonly develop in patients with Type 2 diabetes mellitus.3

The major predictive risk factor for both macrovascular and microvascular risk complications in Type 2 Diabetes is hyperglycaemia. This association is still present after adjustments are made for other known factors including age at diagnosis, sex, ethnic group, systolic blood pressure, lipid concentrations, smoking and albuminuria.4

The Type 2 Diabetes Knowledge Centre aims to provide clear and concise information based on current accepted guidelines on treatment and management. In addition the Knowledge Centre also provides access to key Type 2 diabetes guidelines and details the treatment options available.


References

  1. Haffner SM, Lehto S, Ronnemaa T et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998;339:229-234.
  2. Brun E, Nelson NG, Bennett PH et al. Verona Diabetes Study. Diabetes duration and cause-specific mortality in the Verona Diabetes Study. Diabetes Care 2000;23:1119-1123.
  3. Murea M, Ma L, Freedman BI. Genetic and environmental factors associated with type 2 diabetes and diabetic vascular complications. Rev Diabetic Studies 2012;9:6-22.
  4. Stratton IM, Adler AI, Neil HA et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321:405-412.

Clinical Case Studies

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.

Sickle Cell Lung Disease

Respiratory Medicine & Allergy: Pulmonary Vascular Diseases

Elizabeth Hadley, Consultant Respiratory and General Physician, Barking, Havering and Redbridge Hospitals University NHS Trust, London, UK
Boris Lams, Consultant Respiratory Physicians, Guy's and St Thomas' NHS Foundation Trust, London, UK
Christopher Kosky, Consultant Respiratory Physicians, Guy's and St Thomas' NHS Foundation Trust, London, UK

Case History
A 40-year-old man with known homozygous (HbSS) sickle cell disease (SCD) presented to the emergency department with a three-day history of cough, fever and sweats. He denied any chest pain.

Medical Videos

Advances in Dual Antiplatelet Therapy for Acute Coronary Syndrome (ACS)
Advances in Dual Antiplatelet Therapy for Acute Coronary Syndrome (ACS)
Diabetic Peripheral Arterial Disease (P.A.D.)
Diabetic Peripheral Arterial Disease (P.A.D.)
Does chronic venous insufficiency play a role in MS pathogenesis? Commentary (CONy 2010)
Does chronic venous insufficiency play a role in MS pathogenesis? Commentary (CONy 2010)
Flash Lecture: Changes in Antithrombotic Use
Flash Lecture: Changes in Antithrombotic Use
Rivaroxaban vs enoxaparin for the Prevention of Venous Thromboembolism
Rivaroxaban vs enoxaparin for the Prevention of Venous Thromboembolism
A Guide to the Coronary Angioplasty Procedure
A Guide to the Coronary Angioplasty Procedure

Recent Drug Updates

Medical Images

Pulmonary angiogram
Pulmonary angiogram
Chest radiograph of sickle cell lung disease
Chest radiograph of sickle cell lung disease
Pulmonary arteriovenous malformation
 Pulmonary arteriovenous malformation
Sickle cell lung disease
Sickle cell lung disease

Clinical Guidelines

MI – secondary prevention: Secondary prevention in primary and secondary care for patients following a myocardial infarction

Nov 2013

This guideline offers best practice advice on the care of adults who have had a myocardial..

... infarction.

Unstable angina and NSTEMI

Nov 2013

The term ‘acute coronary syndromes’ encompasses a range of conditions from unstable angina to..

... ST-segment-elevation myocardial infarction (STEMI), arising from thrombus formation on an atheromatous plaque. This guideline addresses the early management of unstable angina and non-ST-segment-elevation myocardial infarction (NSTEMI) once a firm diagnosis has been made and before discharge from hospital. If untreated, the prognosis is poor and mortality high, particularly in people who have had myocardial damage. Appropriate triage, risk assessment and timely use of acute pharmacological or invasive interventions are critical for the prevention of future adverse cardiovascular events (myocardial infarction, stroke, repeat revascularisation or death).

Clinical Trials

Imaging Control Study, 3D Echo, MR and RHC. (PARIS)

22-07-2014

The aim of the study is to intensify the follow up of patients with pulmonary arterial hypertension via modern imaging guided methods in due consideration of the possibilities of three-dimensional echocardiography in order to optimize their specific therapy.

The hypothesis is that the increased use of..

... modern imaging guided tools is essential for the follow up.

Safety of Dabigatran Etexilate in Blood Clot Prevention in Children

21-07-2014

This open-label, single arm prospective cohort study will assess the safety of dabigatran etexilate in secondary prevention of venous thromboembolism in paediatric patients. Children from 0 to less than 18 years of age will be eligible to participate.

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