Transcript Heart Failure (HF) : Overview

Heart Failure (HF) : Overview
Common underlying heart diseases or causes of HF
1. Valvular HD-Rheumatic etiology
2. Cardiomyopathy – Dilated type
3. Ischemic HD – Postmyocardial infarction
Epidemological Data of HF in USA
- 7.5 millions Americans have history of
myocardial infarction, 34% develope
disable HF over 6 years
- 500,000 patients were diagnosed as new
HF cases every year
- Major cause of HF is postmyocardial
infarction cases
Death in Postmyocardial infarction
1. Cardiac sudden death-fatal
ventricular arrhythmia (HR 4-6)
2. Progressive LV remodeling and
failure to Pump failure
Current managements of HF
A. Diuretics
Inotropes and digitalis
Symptomatic relief but No
mortality benefit
B. Evidences of improved morbidity
(hemodynamic) and mortality
B.1 Drugs : ACEI
Beta Blockers : Carvedilol
Metoprolol, Bisoprolol
Aldosterone antagonist (RALES
study, FC III-IV): spironodactone
B.2 Devices : ICD
Cardiac resynchronised
therapy (CRT) – Biventricular
pacings (COMPANION study)
C. Heart transplant : LVAD bridge
to transplant
Future Directions or New Paradigm
in Management HF
1. Loop diuretic (Lasix) caused myocardial
fibrosis (Lopez et all : JACC 2004; 43:202835)
Looking for new (type) diuretic
2. Beta Blockers : What type, How and When
to start
Carvedilol, metoprolol, Bisoprolol
3. The best order of initiating therapy :
ACEI-first VS Beta blocker-first
Bata blocker-first is superior (CIBIS-III,
Sliwa et all : JACC 2004;44:1825-30)
4. New selective aldosterone receptor
antagonist
From Spironolactone to Eplerenone
(EPHESUS study)
5. LVAD bridge to recovery (Sir Magdi
Yacoub)
LVAD
LV rest
to reverse
remodeling of LV (with Digoxin, ACEI, Beta
blocker, Spironolactone)
Residual myocardial atrophy
Physilogic myocardial hypertrophy (by
Beta agonist, Clenbuterol)
Recovered LV function
Removed
LVAD
Pilot study : 19 LVAD patients, 11
improved LV function and had LVAD
removed
6. Cell (Stem Cell) Transplantation
Aims : - Growing of new cardiac
myocytes on scar tissue
- Stimulating angiogenesis to
viable and ischemic myocardium