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Heart failure
Published in Clive Handler, Gerry Coghlan, Nick Brown, Management of Cardiac Problems in Primary Care, 2018
Clive Handler, Gerry Coghlan, Nick Brown
Diastolic heart failure occurs in around 40% of patients, and is due to abnormal filling of the ventricles. The haemodynamic and clinical consequences are similar to those of systolic heart failure. Patients with diastolic heart failure are typically elderly, female, obese, hypertensive and diabetic, and in contrast to patients with systolic heart failure, have preserved or normal left ventricular size, systolic function and ejection fraction. The diagnosis is made by finding clinical features of heart failure with normal systolic function on echocardiography, but signs of abnormal ventricular filling due to diastolic impairment.
Cardiology
Published in Keith Hopcroft, Instant Wisdom for GPs, 2017
Systolic heart failure is an important and life limiting diagnosis that can now be effectively treated, if not cured; however, clinical diagnosis can be fraught with difficulty. In one study, cardiologists were only able to correctly diagnose it at the bedside in 40% of cases. Ankle swelling, breathlessness and lung crepitations are poor discriminators. More specific markers are a displaced apex beat, a raised venous pressure and the presence of a systolic murmur at the apex. BNP, while often used as a screening tool, lacks specificity. An abnormal ECG, particularly in the presence of left bundle branch block or atrial fibrillation, should raise the level of suspicion further. An echocardiogram remains the gold standard test and may also offer insights into the underlying aetiology.
Answers
Published in Calver Pang, Ibraz Hussain, John Mayberry, Pre-Clinical Medicine, 2017
Calver Pang, Ibraz Hussain, John Mayberry
This question focuses on heart failure, a condition where the heart fails to maintain an adequate circulation for the needs of the body despite an adequate filling pressure. There are many causes of failure, for example, hypertension, arrhythmias, but ischaemic heart disease is the primary cause of systolic heart failure. The pathophysiology of heart failure is complex, involving systolic or diastolic dysfunction and neuro-hormonal activation. The symptoms of this condition depend on whether it is left or right heart failure but it is rare for any part of the heart to fail in isolation.
Relation of interleukin-6 levels in COVID-19 patients with major adverse cardiac events
Published in Baylor University Medical Center Proceedings, 2022
Nicholas Nguyen, Hao Nguyen, Chijioke Ukoha, Lawrence Hoang, Chirag Patel, Farukh G. Ikram, Priyanka Acharya, Anmol Dhillon, Manavjot Sidhu
Our population comprised hospitalized patients ≥18 years within Methodist Health System from March to May 2020 who tested positive for COVID-19 by polymerase chain reaction (PCR). After obtaining a list of deidentified patients with positive COVID-19 PCR tests, a retrospective chart review was performed in the EPIC electronic medical record. Specific baseline characteristics were obtained for each patient, including age, sex, race, body mass index (BMI), smoking status, comorbidities, and medication history. Systolic heart failure was defined as an ejection fraction (EF) <45%, and diastolic heart failure was an EF >60% along with impaired left ventricular diastolic filling. Laboratory data related to the present illness were also collected. Peak admission serum IL-6 levels were noted, and IL-6 levels >5 pg/mL were defined as elevated. A MACE was defined as a composite of myocardial infarction, stroke, deep venous thrombosis/pulmonary embolism, or shock requiring vasopressor support. The definition and criteria used to determine these outcomes are noted in the Supplemental Material. This study was approved by the WCG/Aspire Institutional Review Board on June 9, 2020.
Twelve tips for teaching oncology to non-oncologists
Published in Medical Teacher, 2020
Jason A. Freed, Andrew J. Hale, Deepa Rangachari, Daniel N. Ricotta
Due to the sheer number of different cancers, trainees may have erroneous assumptions about the prognoses of many cancer patients (Lycan et al. 2017). Failure to learn accurate prognoses as a trainee can have disastrous consequences later in practice, such as elderly patients with curable malignancies like lymphoma being referred for hospice care without ever seeing an oncologist (Fukita et al. 2013). A quick but effective exercise is to ask trainees which patients on their list have curable cancers. Trainees may also have trouble differentiating the incredibly different prognoses of patients with metastatic tumors. For example, a patient with metastatic cholangiocarcinoma is expected to live just a year from diagnosis even with aggressive treatment (Valle et al. 2010), while a similarly aged patient with metastatic HER2 positive breast cancer may live four times as long (Swain et al. 2015). Another useful exercise is to ask trainees which of their patients is expected to live less than six months. On an inpatient oncology service, this is likely to be a considerable proportion– but trainees might be unable to differentiate patients with temporary complications of potentially curative treatments from patients with end-stage complications of terminal malignancy. It can also be useful to compare the numbers to other severe illnesses, such as systolic heart failure, which are associated with similar prognoses (Stewart et al. 2001; Warraich et al. 2016).
CardioMEMSTM System in the Daily Management of Heart Failure: Review of Current Data and Technique of Implantation
Published in Expert Review of Medical Devices, 2020
Muhammad Asif Mangi, Zeid Nesheiwat, Rehan Kahloon, George V. Moukarbel
A 77-year-old man with a history of systolic heart failure due to nonischemic cardiomyopathy. He was in NYHA Class III symptoms with multiple readmissions for acute systolic heart failure exacerbation. He was referred for placement of CardioMEMSTM PA sensor. Using ultrasound guidance and micropuncture technique, the internal jugular vein was accessed. A Swan-Ganz catheter was advanced and used to perform right heart catheterization and to perform selective left pulmonary arteriography. The CardioMEMSTM PA sensor device was advanced over the Command wire 0.018 into the left pulmonary artery. At that point, there was inability to advance the delivery catheter of the CardioMEMSTM device over the wire. The wire was then pulled back, but it was locked in the delivery catheter and would not advance nor pullback inside the delivery catheter. We then decided to retrieve the assembly including the wire, delivery catheter, and PA sensor. The wire was stuck and could not separate from the catheter itself. This particular device was discarded and was returned to the manufacturer for examination. A new CardioMEMSTM device and delivery catheter were then advanced over the wire to the target site and the CardioMEMSTM device was deployed at that location with no issues [Figure 3].