Angiology Topic Homepage

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

,Type 2 Diabetes CME and Knowledge Centre

Based on current estimates, the global prevalence of Type 2 diabetes mellitus has increased almost 10 fold since 1985 and is expected to rise to 552 million by 2030,1 and when absolute numbers of people with diabetes are considered, it is South East Asia and the West Pacific that are expected to experience the highest increases in prevalence over the coming years.2

An EACCME accredited CME is available, awarded 1 European CME credits (ECMEC's). Consisting of 3 modules:

  • A Review of Newer Therapies for Type 2 Diabetes in Combination with Insulin, John Wilding (Chair)
  • Identifying and Managing the Psychosocial Aspects of Type 2 Diabetes Mellitus, Richard Holt (Faculty)
  • Potential Role of Newer Therapies for Type 2 Diabetes in Combination with Insulin: Interactive Case Discussion, Bernard Charbonnel (Faculty)

Take CME now

The Type 2 Diabetes Knowledge Centre aims to provide clear and concise information based on current accepted guidelines on the treatment and management of patients with this disease. In addition the Knowledge Centre also provides access to key guidelines and a review of treatment options available.

Visit Knowledge Centre 


References

  1. 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.
  2. International Diabetes Federation. Diabetes atlas: second edition. 2002. Available at: www.idf.org/sites/default/files/IDF_Diabetes_Atlas_2ndEd.pdf (accessed 18 November 2013).

 

Clinical Case Studies

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.

Pulmonary Hypertension

Respiratory Medicine & Allergy: Pulmonary Vascular Diseases

Bethia Bradley, Specialist Registrars in Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
Richard Leach, Consultant Respiratory Physicians, Guy's and St Thomas' NHS Foundation Trust, London, UK

Case History
A 26-year-old woman presented to the chest clinic with a two-year history of slowly progressive exertional dyspnoea. At presentation she was experiencing difficulty walking up inclines, keeping up with friends when walking on the flat, climbing two flights of stairs and cleaning the house.

Blog

Would you trust a doctor to decide if you are an appropriate subject for assisted dying? I wouldn't, neither should you, and my colleagues who are not fortunate enough to be retired will be crazy if they allow themselves to be dragged into the process. Proponents of legislative change should man up and face the implications of their proposals, without hiding behind the medical profession.

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Recent Drug Updates

Medical Journal Abstracts on Angiology

Causes and consequences of portal vein thrombosis in 1243 patients with cirrhosis: results of a longitudinal study

Mon 06 Oct 2014 -  Hepatology

Background & Aims: In cirrhosis, portal vein thrombosis (PVT) could be a cause or a consequence of the progression of liver disease. We analyzed data from a prospective trial of ultrasound ...

Small therapeutic window of warfarin in Japanese population

Fri 03 Oct 2014 -  Journal of Cardiology

Atrial fibrillation (AF) is an independent risk factor for ischemic strokes, making the prevention with an oral anticoagulant the mainstay of current clinical practice. An oral anticoagulant such as ...

Medical Images

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

Lipid modification: Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease

Jul 2014

This guideline offers best practice advice on the care of adults at high risk of developing CVD or..

... with established CVD.

Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease

Nov 2013

This EAS Consensus Panel critically appraised evidence relevant to the benefit to risk relationship..

... of functional foods with added plant sterols and/or plant stanols, as components of a healthy lifestyle, to reduce plasma low-density lipoprotein-cholesterol (LDL-C) levels, and thereby lower cardiovascular risk.

Clinical Trials

Renal Sympathetic Denervation by Iberis System in Patients With Uncontrolled Hypertension - Iberis-HTN Registry

17-11-2014

The purpose of this study is to document safety and efficacy of renal sympathetic denervation treatment in subjects with uncontrolled hypertension by using Iberis renal denervation system.

Catheter Ablation Compared With Pharmacological Therapy for Atrial Fibrillation (CAPTAF Trial)

12-11-2014

The objective is to compare the efficacy of 2 treatment strategies, catheter ablation of atrial fibrillation versus optimized pharmacological therapy, in patients with symptomatic atrial fibrillation.

It is a randomized, prospective, controlled, open-label multicentre, parallel-group..

... study including 116 patients. Inclusion criteria are patients aged 30-70 years with symptoms related to atrial fibrillation and who have failed or been intolerant to at least one anti-arrhythmic drug, with at least one atrial fibrillation episode documented on ECG during the previous 12 months and at least one symptomatic episode during the previous 2 months or at least 2 symptomatic episodes of persistent AF in the previous 12 months.

Main exclusion criteria are patients who have tested 2 or more anti-arrhythmic drugs for rhythm control, uncontrolled hypertension, valvular disease requiring anticoagulation, planned valve surgery within 2 years, contraindication to treatment with anticoagulants, heart failure, left atrial diameter > 60 mm, unstable angina or acute myocardial infarction within the last 3 months, cardiac revascularization procedure within the last 6 months, prior cardiac surgery or planned cardiac corrective surgery within 1 year, prior AF ablation procedure.

The primary endpoint is general health-related quality of life at 12 months follow-up. The main secondary endpoints are morbidity and mortality as composite outcome, cardiovascular hospitalization, symptoms, heart failure, left atrial and ventricular function and diameters, exercise capacity, health care economics, rhythm, atrial fibrillation burden, successful versus failed treatment, safety and "cross-overs" over time.

Patients will receive a cardiac monitor, implanted subcutaneously, which will monitor the heart rhythm during a two month "Run-in" period, for the definition of the basic atrial fibrillation burden. Patients will be randomly assigned to an antiarrhythmic drug (for rhythm or rate control) or to left atrial catheter ablation. Evaluation of outcome is at 12, 24, 36 and 48 months of follow-up, while health economy will be evaluated at 24 and 48 months of follow-up.. In case of documented disease progression or unacceptable toxicity, subjects will be switched to the alternative regimen. The main statistical analysis of the primary endpoint will be based on the intention-to-treat population. The trial duration is 48 months.

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