Tag Archives: heart failure

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National survey of patients with AF in the acute medical unit: a day in the life survey Dear Sirs, The first national survey examining the management of atrial fibrillation (AF) within acute medical units up and down the country has just been published in the British Journal of Cardiology.1 Essentially it seems to show that secondary care is just as bad as primary care in initiating warfarin for AF patients. This group of patients is five times more likely to have a thromboembolic cerebrovascular accident than matched populations in sinus rhythm and yet doctors are ineffective at influencing change. This study took place over a 24-hour period

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Introduction Acute heart failure (AHF) has been defined by the European Society of Cardiology (ESC) as the rapid onset of, or change in, symptoms and signs of heart failure, and is a life-threatening condition that requires immediate medical attention.1 These symptoms and signs include shortness of breath at rest or during exertion, fatigue, pulmonary or peripheral fluid retention, a cough, and evidence of an abnormality of the structure or function of the heart at rest.2-4 This change in cardiac function results in an urgent need for therapy, and AHF is among the most common causes of hospitalisation.5 AHF can, therefore, be seen to represen

An overlooked form of SDB Professor Martin Cowie Another form of sleep apnoea – central sleep apnoea with Cheyne Stokes respiration (CSA-CSR) – has received less in-depth investigation than OSA. Nonetheless, it carries significant importance, particularly in heart failure patients. Moderate-to-severe forms have been reported to occur in up to 50% of chronic heart failure patients.4-7 Unlike OSA patients, whose loud night-time snores are punctuated with dramatic apnoeic episodes, CSA-CSR patients exhibit a different style of breathing. In this patient group, night-time breathing follows a waxing and waning pattern in which successive breat

Our letter from Nepal below shows underuse of beta blockers is a widespread problem As outlined in the recent European Society of Cardiology (ESC) guidelines for the treatment of heart failure,1 the pivotal trials with beta blockers were conducted in patients with continuing symptoms and a persistently low ejection fraction (EF), despite treatment with an ACE inhibitor and, in most cases, a diuretic. Despite this, “there is consensus that these treatments are complementary and that a beta blocker and an ACE inhibitor should both be started as soon as possible after diagnosis of heart failure with reduced ejection fraction (HF-REF)”.1

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Mineralocorticoid receptor antagonists Professor Faiez Zannad (Université de Lorraine, Nancy, France), the first of two guest lecturers, who has been an investigator in three major randomised controlled trials (RCT) of mineralocorticoid receptor antagonists (MRA) in heart failure,1-3 opened the first session. There was a particular focus on the recent EMPHASIS-HF trial,3 which recruited heart failure (HF) patients with left ventricular systolic dysfunction (ejection fraction [EF] ≤30%, or EF 30-35% with QRS duration >130 ms) and mild symptoms (New York Heart Association [NYHA] class II). Eplerenone treatment resulted in a 37% relative

Multipolar left ventricular pacing to optimise acute haemodynamic response to cardiac resynchronisation therapy SY Ahsan (presenting author), B Sabberwal, C Hayward, P Lambiase, M Thomas, GG Babu, S Aggarwal, MD Lowe, AWC Chow The Heart Hospital, Institute of Cardiovascular Science, University College Hospitals NHS Foundation Trust, London Purpose: Cardiac resynchronisation therapy (CRT) reduces morbidity and mortality in a sub-group of patients with heart failure, though up to 30% of patients have no benefit. CRT patients are heterogeneous and an individualised approach to CRT may be needed to increase response rate. We evaluated the impact

Introduction As doctors and scientists we are accustomed to breaking down problems and simplifying complex pathology in order to focus our management and identify possible targets for future therapies. The pathophysiology of cardiorenal disease is no different but, as yet, attempts to elucidate the complex interaction between heart and kidneys has failed. Although cardiac and renal disease are often diagnosed together, it is clear that a straightforward causal relationship does not exist. Disease in either serves as a risk factor for disease in the other and perpetuates the progression of that disease, but why this is so is unclear. Whilst th