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Heart Failure

Heart Failure

Heart Failure is a progressive chronic disorder that results in the inability of the heart to pump blood efficiently to the body’s tissues.

Chronic heart failure is an increasing public health problem; the growing prevalence in industrialised countries means that 1-2% of the adult population of these countries are now thought to have chronic heart failure.1-3 Estimates suggest that the prevalence in Europe, USA and Japan could increase by approximately 16.5% over the next ten years.4

The prevalence of post-myocardial infarction heart failure is less well known as it is difficult to distinguish between pre-existing and incident heart failure. However current estimates suggest that approximately 1 in 5 patients hospitalised with an acute coronary syndrome either present with heart failure or develop heart failure during their hospital stay.5

Many of the signs and symptoms of heart failure are non-specific and vary in severity depending on the disease class. The most common of these are breathlessness, fatigue, exercise intolerance, and fluid retention as evidenced by ankle swelling, peripheral oedema, and an elevated jugular venous pressure.6

Due to the non-specific nature of symptoms, the diagnosis of heart failure can be difficult. Tests can include echocardiogram, ECG, chest X-ray, laboratory tests. Following a positive diagnosis heart failure is classified into functional classes that relate to disease severity.

Management of heart failure involves lifestyle modifications, pharmacological treatment and occasionally surgery. In patients with chronic heart failure, optimal therapy involves treatment with diuretics, ACE inhibitors, certain β-blockers and a mineralocorticoid receptor antagonist.

The Heart Failure Knowledge Centre brings together current information related to chronic heart failure and post-myocardial infarction, including:

  • Epidemiology
  • Symptoms and Diagnosis
  • Classification
  • Treatment Options

Enter the Heart Failure Knowledge Centre


References

  1. Zannad F, et al. Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL Study. Journal of the American College of Cardiology 1999; 33(3):734-742.
  2. Cowie MR, et al. The epidemiology of heart failure. European Heart Journal 1997;18(2):208-225.
  3. Mosterd A, Hoes A. Clinical epidemiology of heart failure. Heart 2007; 93:1137-1146.
  4. Decision Resources. Chronic Heart Failure. Cardium Study No.4 A Pharmacor Service. 2008.
  5. Steg PG, Dabbous OH, et al. Determinants and prognostic impact of heart failure complicating acutecoronary syndromes. Observations from the Global Registry of Acute Coronary Events (GRACE). Circulation2004;109:494-9.
  6. NICE Clinical Guideline No 108. Chronic Heart Failure. National clinical guideline for diagnosis and management in primary and secondary care. 2010.

Type 2 Diabetes Knowledge Centre

Type 2 Diabetes Knowledge Centre

The Type 2 Diabetes Knowledge Centre has been developed with the aim of providing clear and concise information based on current accepted guidelines on treatment and management.

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 diabetic 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 commonly developed in patients with Type 2 diabetes mellitus.3 The correlation between insulin resistance and cardiovascular disease has been demonstrated in several clinical studies.4,5

Further information on the cardiovascular complications associated with Type 2 diabetes mellitus can be found in the Knowledge Centre.


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.
  5. Salomaa V, Riley W, Kark JD, Nardo C, Folsom AR. Arterial disease/hypertension/angiotensin system: non-insulin-dependent diabetes mellitus and fasting glucose and insulin concentrations are associated with arterial stiffness indexes. The ARIC study. Circulation 1995;91:1432-1443.

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

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Assessment of coronary ischaemia by myocardial perfusion dipyridamole stress technetium–99 m tetrofosmin, single–photon emission computed tomography, and coronary angiography in children with Kawasaki disease: pre– and post–coronary bypass grafting

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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.
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