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Review the cases presented at Heart Failure 2018 and test your knowledge!
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Meet the virtual patients of Heart Failure 2018!
One month ago Kelly had been hospitalized for chest pain. She was diagnosed acute myocarditis by chest pain, elevated troponins and ST-depressions in V3-V5. Echocardiography and coronary angiography were normal. Ibuprofein 600mg 3xday and bisoprolol 2.5mg 1xday were prescribed.
39-year old woman presented to the ER because of 2 weeks’ history of discomfort at right costal margin, abdominal distension, lower limb edema, dizziness and blurring of vision.
Diagnostic workup and acute stabilization of myocarditis.
Starting of heart failure and immunomodulic chronic medication.Indications for Implantable Cardioverter Defibrillator (ICD).
Asthma; Pseudotumor in left eye (diagnosed 1.5 years earlier, cortison treatment ended six months ago); Occasional dyspepsia; Acute myocarditis (diagnosed 1 month ago).
Blood pressure (mmHg): 187 / 71Heart rate (bpm): 90Respiratory rate (/min): 20O₂ saturation (%): 99.9Blood glucose (mg/dL): 118Temperature (ºC): 36.7Hemoglobin (g/dL): 14.5Urinary output (mL/kg/h): 0.67
Mr Blanchard has an HIV infection lasting 32 years. Anterior myocardial infarction 8 years ago treated by thrombolysis, an Inferior myocardial infarction 6 years ago treated by right coronary stenting. Severe ischemic mitral regurgitation despite a percutaneous mitral clip. Defibrillator for primary prevention. Cardiac resynchronization therapy
The patient has a LVEF of 30% with severe mitral regurgitation despite a mitral clip. For the past month, the patient has complained of a NYHA 4 grade dyspnea with increasing orthopnea, a 2 kg weight gain and a cough. His treatments include: furosemide 500 mg once daily, bisoprolol 10 mg once daily, ramipril 2.5 mg once daily, kardegic 75 mg once daily, rosuvastatin 10 mg once daily and he is also treated for his HIV infection.
Hospitalized twice in the past 12 months. During last hospitalization it was impossible to increase medication doses. Peak oxygen consumption (VO2) of 11.5 ml/kg/min.CD4 count 570 cells/µL and undetectable HIV viral load for 1 year
Specificities of heart transplantation in HIV recipients.
Perform pre-transplant evaluation on a patient with end-stage heart failure and HIVRecognize HIV infection as not being a contraindication for heart transplantationEnumerate requirements for heart transplantation on an HIV patient
HIV; Dyslipidemia; Severe heart failure (NYHA grade 4).
Blood pressure (mmHg): 95/75Heart rate (bpm): 74Respiratory rate (/min): 32O₂ saturation (%): 98Blood glucose (mg/dL): 102Temperature (ºC): 36.7Hemoglobin (g/dL): 14.1Urinary output (mL/kg/h): 0.67
Mr Hayden's health has deteriorated progressively during the past 5 years, significantly impacting his quality of life. During this period, Mr Hayden was hospitalized several times, and ended up hospitalized much more frequently in the past year.
43-year old male with 1-year history of recurrent heart failure hospitalizations was admitted to the ICU due to decompensated heart failure. He has complained of fatigue and dyspnoea on exertion (NYHA III) for a few weeks. Physical examination showed hypotension, abdominal distension and peripheral oedema.
5-years ago the patient, without any previous chronic conditions, was admitted to the internal medicine ward due to fatigue and dyspnoea on exertion which started after mild upper respiratory tract infection. The suspicion of myocarditis was raised at that time. Troponin and inflammation markers were normal and echo did not reveal any abnormalities.
3 years later the patient started to suffer from ankles oedema, which was asymmetric and more visible around the right ankle. The ultrasound showed thrombophlebitis of the right lower limb. After initial treatment with enoxaparine thrombophlebitis recurred and treatment with warfarin was implemented.
Last year patient was hospitalized twice in the internal medicine ward due to signs and symptoms of decompensated heart failure: fatigue, dyspnoea on exertion, recurrent ankle oedema. ECHO study at that time revealed the enlarged left atrium (49 mm in PLAX view) without any other abnormalities described in the report. The diagnosis of chronic heart failure with preserved ejection fraction was proposed. The patient received chronic treatment: ramipril 2.5 mg, furosemide 120 mg, spironolactone 25 mg, warfarin 5 mg (according to INR level) - doses per day.
Constrictive pericarditis – rare but potentially curable cause of heart failure in young patient.
Constrictive pericarditis – rare but potentially curable cause of heart failure in young patient. Focus on specific clinical manifestation of pericardial diseases. Role of early echocardiography in patients admitted to ICU due to decompensated heart failure. Evaluation of diastolic function in patients with pericardial diseases. Searching for indirect signs of constriction in echo imaging. Important role of multi-modality imaging of pericardial disease. Surgical treatment of constrictive pericarditis crucial for patient’s recovery.
Blood pressure (mmHg): 88 / 64Heart rate (bpm): 75Respiratory rate (/min): 16O₂ saturation (%): 98Blood glucose (mg/dL): 110Temperature (ºC): 36.8Hemoglobin (g/dL): 14.1Urinary output (mL/kg/h): 0.67
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.
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.
BP (mmHg): 145/70HR (bpm): 70RR (/min): 16O2 saturation (%): 99Glycemia (mg/dL): 120Glycemia (mmol/L): 6.7Temperature (ºC): 36.0Temperature (ºF): 97
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.
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.
Echocardiography in the context of cardiogenic shock.
22.5 (Normal weight)
BP (mmHg): 139/80HR (bpm): 70RR (/min): 16O2 saturation (%): 99Glycemia (mg/dL): 120Glycemia (mmol/L): 6.7Temperature (ºC): 36.0Temperature (ºF): 97
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.
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.
Identify hemodynamic deterioration, make a critical judgement, decide how to treat a critically ill patient.
To understand the right heart failure physiology and the optimised way of treatment.
23.9 (Normal weight)
BP (mmHg): 140/85HR (bpm): 81RR (/min): 16O2 saturation (%): 98Glycemia (mg/dL): 98Glycemia (mmol/L): 5.44Temperature (ºC): 36.6Temperature (ºF): 98
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