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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

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Infection: Infections in Critical Care

Iain Gould, Consultant Medical Microbiologist, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
Vhairi M. Bateman, Specialist Registrar in Infectious Diseases and Microbiology,, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK

Case History
A 48-year-old man was admitted to hospital suffering from smoke inhalation following a house fire.

Meningococcal Meningitis

Infection: Community-acquired Bloodstream Infections

Christopher Duncan, Research Fellow, Sir William Dunn School of Pathology, University of Oxford, Oxford, UK

Case History
A 36-year-old woman was admitted with sudden-onset severe occipital headache, photophobia and vomiting. On physical examination she was afebrile, with obvious photophobia and neck stiffness but no skin rashes.

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Recent Drug Updates

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

Comparative PK PD Study in PAH Patients (Fox vs. I-Neb)

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Administration of iloprost aerosol comparing two nebulizers: FOX and I-Neb

Computed Tomography Angiography Prediction Score for Percutaneous Revascularization of Chronic Total Occlusions (CT-RECTOR)

22-12-2013

Chronic total occlusions (CTO) are encountered in almost one-fourth of patients undergoing coronary angiography. The presence of an untreated CTO has been related to adverse clinical prognosis, both in stable angina and acute myocardial infarction, and is often associated with persistent symptomatic angina. Depending..

... on their symptomatic and functional status as well as anatomical complexity, CTO can be treated by optimal medical therapy only or therapy combined with coronary revascularization. The potential benefits of percutaneous coronary intervention (PCI) in CTO include symptom relief, improved left ventricular function, and potentially a survival advantage associated with success when compared with failed revascularization. Of note, marked advances in endovascular techniques and device technology have resulted in substantial improvements of procedural success rates of PCI in CTO. In spite of these advances, the vast majority of patients with CTO are still being managed medically or referred for coronary bypass surgery rather than PCI. The most common reason for deferring PCI in patients with CTO appears to be the uncertainty of predicting the procedural outcome of percutaneous revascularization. Further barriers to attempting CTO by PCI include the difficulty of gauging the time required for the procedure and the use of resources. The CT-RECTOR (Computed Tomography REgistry of Chronic Total Occlusion Revascularization) study was designed to evaluate the application of coronary computed tomography angiography (CTA) for the prediction of procedural outcome of PCI in CTO in an international patient population. The main purpose of this multicenter registry is to develop a noninvasive CTA-based prediction tool (CT-RECTOR Score) for grading CTO suitability for PCI.
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