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Virtual Case Area

New at Heart Failure 2016: Virtual Case Area!

New at Heart Failure 2016, delegates were given the opportunity to experience virtual and interactive cases on a digital simulator!

 



The launch of the Virtual Case Area was a great success thanks to the presenters and it's interactive audience!

We look forward to renew this at Heart Failure 2017 in Paris!

 

What is the Virtual Case Area?

• Heart Failure clinical cases were created and presented by members of the Heart specialist Of Tomorrow (HOT)
• Demonstrations were done on an interactive digital simulator
• HOT presenters animated their challenging clinical cases and shared their feedback & take-home messages
• Presentations took place during Coffee Breaks & the HOT/ HIT (Heart Imagers of Tomorrow) session

Meet Wesley: a patient with AN Infective endocarditis & acute aortic regurgitation

Context

Patient presenting to the emergency department (ED) for worsening dyspnea since 3 weeks; dyspnea at rest (NYHA IV) and orthopnea at presentation. Given the evidence of lung congestion at chest X-ray the patient is admitted to the ICU.

Briefing

The patient complains of remittent fever exacerbating in the evening hours since a couple of months, temperature rarely exceeds 38°C, anorexia and weight loss, about 5 Kg in the previous 4 to 5 weeks. Transient global amnesia about two months before, neuroimaging not performed. Current medical therapy is Amlodipine 5 mg once daily, Ramipril 5 mg once daily, Aspirin 100 mg once daily.

General learning objectives

  • Echocardiography represents a fundamental diagnostic tool for patients presenting to the ICU for dyspnea. Early transthoracic echocardiography (TTE) in the ICU can be of fundamental value for diagnosis of acute heart failure syndromes and to identify life-threatening conditions, such as complicated infective endocarditis (IE), requiring immediate treatment.
  • Echocardiography has a crucial role in the clinical management of patients with IE and may dictate timing for surgical treatment. Identification of large, mobile vegetations, left ventricular systolic dysfunction and severe aortic regurgitation, together with the evidence of systemic embolization, led in this case to urgent surgery.

Specific learning objectives

  • Echocardiography needs to be performed (and eventually repeated) by an experienced operator, especially when the clinical suspicion of IE is elevated. When performed by a non-experienced operator, echocardiography may fail to detect endocarditic vegetations. When clinical suspicion is high, the patient should be sent for transoesophageal echocardiography (TEE), even with negative TTE.
  • Clinical management of patients with IE needs to be performed by the Endocarditis Team. Evaluation and decision making in patients with IE require competences from different professionals, including clinical cardiologists, imaging specialists, infectivologists, cardiac surgeons.
  • In selected circumstances, TEE may not be performed in patients with suspected IE. Although TEE is highly recommended in patients with suspected IE, in some cases it may not be performed. In such circumstances, a TTE of good quality may be sufficient for diagnosis and to plan treatment and follow-up.

Patient characterisation

Patient name:

Wesley Steffen

Age:

68

BMI:

26.8 (Overweight)

Sex:

Male

Weight (kg):

84

Height (cm):

177

Weight (lb):

185

Height (in):

70

Chronic conditions:

Hypertension.

Basal parameters

(before acute event):

BP (mmHg):

145 / 70

 

HR (bpm):

70

 

 

 

 

RR (/min):

16

 

O saturation (%):

99

 

Glycemia (mg/dL):

120

Glycemia (mmol/L):

6.7

Temperature (ºC):

36.0

Temperature (ºF)

97

 

Watch the case presentation on SP&P

Meet JOHN: a PATIENT WITH CARDIOGENIC SHOCK

Context

Patient initially collapsed on the street and was resuscitated. Presented Coronary artery disease (acute occlusion of the prox. LAD and RCX) with severely depressed ejection fraction, EF=30% in echocardiography. The patient presented with severe and persistent cardiogenic shock.

Briefing

Patient was referred to hospital due to persistent cardiogenic shock. With positive inotropic treatment, Levosimendan, and negative balance, patient was stabilized. HF treatment was started and patient was referred to intermediate care. Despite treatment, patient did not improve and evaluation for VADs implantation and TPL was started. However, patient deteriorated and was referred to the ICU again.

General learning objectives

Echocardiography in the context of cardiogenic shock.

Specific learning objectives

  • Echo helps to exclude mechanical complications (acute MR, ventricle septum or free wall rupture) after acute MI;
  • Echo reveals systolic and diastolic function of the LV and gives important information on filling pressures;
  • Echo gives information in the right ventricular function which is particularly important considering assist device implantation;
  • Echo can exclude pericardial effusion as a cause of cardiogenic shock;
  • Echo visualizes Thrombi. 

Patient characterisation

Patient name:

John Garner

Age:

51

BMI:

22.5 (Normal weight)

Sex:

Male

Weight (kg):

65

Height (cm):

170

Weight (lb):

143

Height (in):

67

Chronic conditions:

-

Basal parameters

(before acute event):

BP (mmHg):

139 / 80

 

HR (bpm):

70

 

 

 

 

RR (/min):

16

 

O saturation (%):

99

 

Glycemia (mg/dL):

120

Glycemia (mmol/L):

6.7

Temperature (ºC):

36.0

Temperature (ºF)

97

 

Watch the case presentation on SP&P

Meet MICKEY: a PATIENT WITH FAILING OR NOT FAILING RIGHT MYOCARDIUM?

Context

Mickey suffered an aortic aneurysm rupture and was transferred immediately to a specialist heart and lung centre, for an emergency surgical repair of his ruptured aneurysm. Although Mickey was hemodynamically stable after surgery, 8 hours post repair his clinical condition severely deteriorated.

Briefing

Patient is male, 69 years old. Recently operated to correct a ruptured aortic aneurism. Shortly after surgery, the patient was hemodynamically stable. Currently, 8 hours post repair, the patient is suffering profound peripheral vasoconstriction, higher oxygen demands, higher inotropic demands and his blood pressure is dropping acutely.

General learning objectives

Identify hemodynamic deterioration, make a critical judgement, decide how to treat a critically ill patient.

Specific learning objectives

To understand the right heart failure physiology and the optimised way of treatment.

Patient characterisation

Patient name:

Mickey Goode

Age:

69

BMI:

23.9 (Normal weight)

Sex:

Male

Weight (kg):

75

Height (cm):

177

Weight (lb):

165

Height (in):

70

Chronic conditions:

Hypertension; Diverticulitis.

Basal parameters

(before acute event):

BP (mmHg):

140 / 85

 

HR (bpm):

81

 

 

RR (/min):

16

 

O saturation (%):

98

 

Glycemia (mg/dL):

98

Glycemia (mmol/L):

5.44

Temperature (ºC):

36.6

Temperature (ºF)

98

Hemoglobin (g/dL)

-

 

 

 

 

Watch the case presentation on SP&P