Jan 13, 2023
This podcast, Dr. Peter Eckman, a cardiologist and heart failure specialist, with Minneapolis Heart Institute, discusses heart failure and why it is an extensive medical issue.
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SHOW NOTES:
*See the attachment for additional
information.
Heart Failure
(HF)
- Can occur without congestion or fluid
retention
- Characterized by fatigue, fluid
retention, SOB, PND, orthopnea
- We should consider the same urgency for heart failure as patients
with CAD and CA.
Heart Failure
Preserved/Reduced Ejection Fraction (HFpEF/HFrEF)
-
HFpEF is a Preserved Ejcetion Fraction over about 50%
- HFpEF - congestive phenotype more of a fluid retention
- an exercise intolerant phenotupe where the
patient becomes intolerant of exercise induced dyspnea.
- Pulm HTN phenotype
- Increased pressure in the heart that gets
transmitted to the lungs
- HRrEF is Reduced EF is usually below 40%
Medications
-
4 classes of medications (MRAs, BB, SGLT2, ARNIs)
- Treatment with mineralocorticoid receptor antagonists (MRAs) has
been demonstrated to improve clinical outcomes in patients with
HFrEF with mild to severe symptoms and also in patients with left
ventricular dysfunciton after myocardial infarction.
- SGLT2 inhibitors reduced the risk of cardiovascular death and
hospitalizations for heart failure in a broad range of patients
with heart failure, supporting their role as a foundational therapy
for heart failure, irrespective of ejection fraction or care
setting.
- ARNI (angiotensin receptor/neprilysin inhibitor) medication is a
newer treatment for heart failure. The combination of sacubitril
and valsartan has helped people live longer and have a better
quality of life.
- Comprehensive EF therapy involves BB, ARNI, MRAs, angiotensin
receptor/neprilysin inhibitors. Spironolactone, SGLT2
inhibitors.
Treatment
-
Traditional
therapy usually involves a BB and ACE inhibitor.
- Currently we should be looking at comprehensive therapy when it
comes to HF treatment.
- STOP USING
LISINOPRIL.
- SGLT2 inhibitors
contraindicated ketoacidosis, amputation UTI, weight loss
- (SGLT2 inhibitors) DAPA-HF trial showed that
dapagliflozin was superior to placebo at preventing cardiovascular
deaths and heart failure events among patients with heart
failure. (Source:
https://www.nejm.org/doi/full/10.1056/NEJMoa1911303#article_citing_articles
)
- Catheterization
- a vast majority of HF patients will need a right heart
catheterization.
- Cardiac pulmonary
pressure monitoring Cardio MEMS - same day outpatient
surgery which helps with medication adjustments and hospitalization
in half. Works regardless of EF.
- CardioVere laser
spectroscopy which uses different wavelengths to detect
light characteristics to determine the level of edema/fluid present
wihin someone's tissues. Currently in development.
- Casana is a
toilet seat with certain sensors that detect and monitor impedance
that check levels between different tissues, monitors HR and
weight.
- Cardiac contractility
modulation causing electrical stumulation during a
particular contraction of the myocyets it will augment potential
(like a pacemeaker).
-CORCHINCH - HF
trial catheter based device that cinches up the heart, thereby
making it smaller. It works more
efficiently. (Source: Clinical Evaluation of the
AccuCinch® Ventricular Restoration System in Patients Who
Present With Symptomatic Heart Failure With Reduced Ejection
Fraction (HFrEF): The
CORCINCH-HF Study)
Novel
Treatments
- Atrial shunting procedure is
investigational trials. Potentially impactful in exercise capacity
and pressures but stay tuned as the verdict is not out. HfPEF
exercise induced intolerance may be the best candidate.
- SVC trial
feasibility trial more durable effects of cardiac
output. Stay tuned.
- LVAD for
advanced therapies. Sometimes a bridge for candidacy as well as
recovery.
- Biventricular
pacing has shown promise.
*Heart failure is a problematic clinical disease entity with significant morbidity and mortality often leading to comprehensive medical management. It is often beneficial to enlist the help of our heart failure colleagues for these complicated patients.
Thanks to Dr. Peter Eckman - MHI heart failure specialist for his knowledge and contribution to this podcast.
Please check out the additonal show notes for additional information/resources.