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 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

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.

Pulmonary Arteriovenous Malformation

Respiratory Medicine & Allergy: Pulmonary Vascular Diseases

Elizabeth Hadley, Consultant Respiratory and General Physician, Barking, Havering and Redbridge Hospitals University NHS Trust, London, UK

Case History
A 45-year-old lady was referred to the chest clinic because of dyspnoea. She had gradually become more breathless over two years and was now breathless at rest.

Medical Videos

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)
A Guide to the Coronary Angioplasty Procedure
A Guide to the Coronary Angioplasty Procedure
Rivaroxaban vs enoxaparin for the Prevention of Venous Thromboembolism
Rivaroxaban vs enoxaparin for the Prevention of Venous Thromboembolism
Diabetic Peripheral Arterial Disease (P.A.D.)
Diabetic Peripheral Arterial Disease (P.A.D.)
Advances in Dual Antiplatelet Therapy for Acute Coronary Syndrome (ACS)
Advances in Dual Antiplatelet Therapy for Acute Coronary Syndrome (ACS)
Flash Lecture: Changes in Antithrombotic Use
Flash Lecture: Changes in Antithrombotic Use

Recent Drug Updates

Medical Images

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

Non-invasive Assessment of Pulmonary Artery Pressure

21-08-2014

The assessment of pulmonary artery pressure (PAP) and parameters describing right ventricular function stand in the focus of the diagnosis and clinical management of pulmonary hypertension (PH). Right heart catheterization (RHC) is the gold standard..

... method to measure PAP and to provide hemodynamic information on right ventricular function. However, due to its invasive nature, RHC is not optimal for screening and for close monitoring of the disease. Therefore, the development of non-invasive methods providing reliable PAP measurements and right ventricular functional parameters would be of major benefit.

Today, the most often used comprehensive non-invasive method for these purposes is echocardiography. However, the method has limitations; in many cases PAP is significantly under- or overestimated - especially in subjects with co-existing pulmonary diseases. Regarding right ventricular function, although novel echocardiography parameters appear to be promising, they have not yet been evaluated in all forms of PH.

Another emerging non-invasive method is cardiac magnetic resonance imaging (MRI). MRI is considered to be as gold standard for the non-invasive assessment of right ventricular function. In addition, our group showed that with a special approach ("vortex method"), MRI enables the determination of PAP with physiologic accuracy, but the method has not yet been validated systematically in different forms of PH.

All patients undergoing right heart catheterization in our clinic are candidates for the study. Excluded will be patients not eligible for MRI or declining to take part in the study. MRI and Echocardiography will be performed within two weeks of the RHC.

Hypothesis:

  1. MRI is superior to echocardiography to non-invasively determine mean PAP in a broad collective of patients with PH of diverse ethology.
  2. MRI derived right ventricular functional parameters correlate better to invasive measurements and to established prognostic parameters than echocardiography derived right ventricular functional parameters.
  3. Novel right ventricular tissue Doppler parameters add substantially to "classical" echocardiography parameters to describe right ventricular function.

Treatment of HYpertension: Morning Versus Evening (THYME)

08-08-2014

Rationale:

The nocturnal blood pressure mean is an independent and stronger predictor of cardiovascular disease (CVD) risk than either daytime office, awake or 24hour mean blood pressure. In general,..

... when nocturnal blood pressure does not decline CVD risk is higher, usually referred to as "dippers" versus "non-dippers". Evening administration of treatment might lower nocturnal blood pressure more effectively than morning administration, which is most commonly advised.

The main hypothesis of this study is that evening administration of antihypertensive medication might resume the dipping pattern in non-dippers and as a consequence might reduce CVD risk more than morning administration.

Primary objective (in short):

-to prove that evening administration of enalapril/hydrochlorothiazide in non-dippers can resume a dipping blood pressure pattern in non-dippers

Study design: A double-blind placebo-controlled cross-over study Each person will use for one period of six weeks enalapril/hydrochlorothiazide in the morning and placebo in the evening, and one period of six weeks the other way around

Back to top