文档介绍：Heart Failure A Disease for the Internist
Dr Chris Davidson
Sussex Cardiac Centre
BRIGHTON UK
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EFIM Beziers 2007
Heart Failure – a typical case?
Medical Assessment Unit
78 year old woman
Hypertension ; type II Diabetes
AF 110/min, 180/80, JVP+, oedema++
CXR: cardiomegaly, pulmonary congestion
ECG: AF, LBBB
Given iv Frusemide 80mg with a ‘good’ diuresis and feels better today
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EFIM Beziers 2007
Heart Failure A Disease for the Internist
Who looks after patients with Heart Failure?
Use of Evidence-based Treatments
The problem of Heart Failure with ‘Preserved’ LV function
Co-Morbidity in Heart Failure
How do we prevent early relapse?
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EFIM Beziers 2007
EuroHeart Failure Survey
11,327 diagnosis HF
Mean age 71 years; 47% women
GIM / geriatrics 55%, cardiology 45%
CHD 66%, Valve disease 29%, DCM 5%
HF principle reason for admission in 40%
LVSD in 46%: male > female
European Heart Journal (2003) 24, 442–463
Registry of 46,786 consecutive admissions to general medicine and cardiology wards in 24 European countries over a 6 week period 2001-2
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EFIM Beziers 2007
Heart Failure in France Cohen-Solal et al European Heart Journal (2000) 21, 763–769
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EFIM Beziers 2007
HEART FAILURE
How Serious?
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EFIM Beziers 2007
Epidemiology of Heart Failure: Framingham Study
Hypertension 76% 79%
CHD 46% 27%
Rheumatic 2% 3%
Other 11% 17%
MORTALITY 82% 67%
(6 Year)
MALE
FEMALE
Ho et al Circulation 1993;88:107-115
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EFIM Beziers 2007
MORE MALIGNANT THAN CANCER? Stewart S et al. Eur. J Heart Failure (2001) 3 315-322
Reference: Stewart et al. Eur J Heart Failure 2001
Five year Survival of Patients admitted to Hospital in Scotland 1991
28%
28%
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EFIM Beziers 2007
HEART FAILURE
What are the mended treatments?
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EFIM Beziers 2007
HF – Trial Evidence
ACE inhibitors
Vasodilators: Hydrallazine/Nitrate
Beta-Blockers
Spironolactone
Angiotensin Receptor Blockers
Exercise Training
Biventricular Pacing / Defibrillators
Cardiac Transplantation
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EFIM Bezi