; Acute heart failure Martin Radvan [USEMAP] What we will talk about? •Patophysiology •Clinical signs •Diagnosis •Therapy • [USEMAP] Definition •Acute heart failure (AHF) is generally defined as the rapid development or change of symptoms and signs of heart failure that requires urgent medical attentionis •No new mediaction for last 30 years [USEMAP] Definition •Symptoms related to pulmonary congestion due to elevated left ventricle filling pressures with or without low cardiac output [USEMAP] Definition •De novo x acute decompensation of chronic heart failure • •Cardiogenic shock [USEMAP] Epidemiology •No1 reason for hospitalisation in people older than 65 years •65-75% known HF before hospitalisation •25-55% preserved ejection fraction (HFpEF) • • [USEMAP] Diagnosis •Anamnesis •Clinical signs •Examination: perfusion and volume status •ECG •Echocardiography •Labs •X-ray, CT, coronarography, etc. [USEMAP] Signs and symptoms •noisy syndrome, rapid developement •elevated jugular venous pressure •pulmonary edema •+S3 (gallop) •pulmonary crackles •peripheral oedema •orthopnoe • [USEMAP] Signs and symptoms •Noisy syndrome, rapid developement •elevated jugular venous pressure •Pulmonary edema •+S3 (gallop) •pulmonary crackles •oedema •orthopnoe • [USEMAP] • • [USEMAP] • • AHF management ESC guideliness 2012.bmp [USEMAP] • • AHF management ESC guideliness 2012.bmp [USEMAP] • • AHF management ESC guideliness 2012.bmp [USEMAP] • • AHF management ESC guideliness 2012.bmp [USEMAP] • • AHF management ESC guideliness 2012.bmp [USEMAP] • • AHF management ESC guideliness 2012.bmp [USEMAP] • • AHF management ESC guideliness 2012.bmp ESC guideliness A a CHF EHJ 2012.bmp [USEMAP] Pathopysiology •Dry-warm • Wet –warm Wet-cold Dry-cold [USEMAP] Pathopysiology •Dry-warm •Well perfused, normovolemic • Wet –warm Congestion, well perfused Wet-cold Congested, hypoperfused Dry-cold Hypoperfused, hypovolemic [USEMAP] Pathopysiology Wet –warm Congestion, well perfused Wet-cold Congested, hypoperfused Dry-cold Hypoperfused, hypovolemic [USEMAP] Pathopysiology Wet –warm Congestion, well perfused Wet-cold Congested, hypoperfused Dry-cold Hypoperfused, hypovolemic [USEMAP] Pathopysiology Wet –warm Congestion, well perfused Duiretics, vasodilatators Wet-cold Congested, hypoperfused Inotropes, MCS Dry-cold Hypoperfused, hypovolemic Water challenge, inotropes [USEMAP] Pathopysiology – Forrester classification (PCWP, CI) Wet –warm Congestion, well perfused Duiretics, vasodilatators 90-95% Wet-cold Congested, hypoperfused Inotropes, MCS 5-10% Dry-cold Hypoperfused, hypovolemic Water challenge, inotropes [USEMAP] PCWP, CI •PCWP •Invasive vs. non-invasive measurment •Pressure in left atrium •Volume status Cardiac index Invasive vs. Non-invasive measurment 2,2L/min/m2 Cardiac output Degree of perfusion [USEMAP] PCWP, CI •PCWP •Invasive vs. non-invasive measurment •Pressure in left atrium •Volume status Cardiac index Invasive vs. noninvasive measurment 2,2L/min/m2 Cardiac output Degree of perfusion [USEMAP] PCWP, CI •PCWP •Invasive vs. non-invasive measurment •Pressure in left atrium •Volume status Cardiac index Invasive vs. noninvasive measurment 2,2L/min/m2 Cardiac output Degree of perfusion [USEMAP] PCWP, CI •PCWP •Invasive vs. non-invasive measurment •Pressure in left atrium •Volume status Cardiac index Invasive vs. non-invasive measurment 2,2L/min/m2 Cardiac output Degree of perfusion [USEMAP] Labs •ECG – rarely normal •X-ray: congestion, normal heart size •Echocardiography – heart, lungs •BNP, NT-proBNP, troponin [USEMAP] Labs •ECG •X-ray: congestion, normal heart size •BNP, NT-proBNP, troponin [USEMAP] Labs •ECG •X-ray: congestion, normal heart size •BNP, NT-proBNP, troponin C:\Users\32319\Předánšky\Bez názvu.png [USEMAP] Clinical course • [USEMAP] Pulmonary aedema • [USEMAP] Therapy of pulmonary aedema? [USEMAP] Therapy of pulmonary aedema •Oxygen •Morphin •Vasodilatation (blood presure control) •Furosemide •Therapy of the cause [USEMAP] Classifications • [USEMAP] Cardiogenic shock •Acute HF in naive patients •Myocardial injury •Arrythmia •Valvular disease •Obstructive shock •Tamponade •… • • [USEMAP] Diagnosis • [USEMAP] Pharmacotherapy of cardiogenic shock •Inotropes: noradrenalin, dobutamin, adrenalin, milrinon, levosimendan • •Ultrafiltration •Furosemide •Therapy of the cause [USEMAP] MCS •Intra-aortic balloon counterpulsation •LVAD •Total artificial heart •ECMO •Impella • •Bridge to recovery/decision/transplantation •Destinantion therapy [USEMAP] MCS •Intraaortic balloon contrapulsation •LVAD •Total artificial heart •ECMO •Impella • •Bridge to recovery/decision/transplantation •Destinantion therapy [USEMAP] IABC • [USEMAP] ECMO • [USEMAP] ECMO • [USEMAP] ECMO • [USEMAP] Impella • [USEMAP] LVAD • C:\Users\32319\Bez názvu.png [USEMAP] Transplantation • •Age? •Life expectancy (except heart) •Spiroergometry VO2max • •Imunosupression •Rejection, infection •Vasculopathy of the graft • [USEMAP] Conclusions •Acute HF in naive patients •Acute decompensation of chronic HF •Fluid and perfusion status •Cause of HF/decompensation •Early goal directed echocardiography •Early therapy •Early recognition of therapy failure • • [USEMAP] Your blood pressureis a little highDe motivation, us,demotivation posters,auto •Thanks for the attention [USEMAP]