Khác biệt về biểu hiện và đáp ứng của suy tim mới so với đợt mất bù của suy tim mạn tính

Differences in Presentations and Responses to Management of New Onset Heart Failure versus Long Standing Heart Failure Presenter: Nguyễn Văn Việt Thắng BACKGROUND Current definition of Heart Failure is vague and impractical  New classification of Heart Failure based on a new test – the SEFV test  Treatment according to the result of the test BACKGROUND The SEFV test Method The result Fluid distribution Three compartments of the body Intravascular compartments Intra-arterial compartment Extravascular compartment Intra-venous compartment New Non-Invasive SEFV test Size and Expansion of the Femoral Vein test • The SEFV is the ultrasound study examining the size of the femoral vein and its expansion with cough • The ultrasound plane of the femoral artery and vein to be checked is the coronal plane immediately proximal to the bifurcation of the superficial and deep femoral artery SEFV Size and Expansibility of the Femoral Vein test SEFV Here at the distal end of the common femoral artery, the coronal plane of the artery is seen as a single round structure which pulsates Next to it is the femoral vein Principles of SEFV The first principle: The volume of blood going through the femoral artery and returning through the common femoral vein should be the same Principles of SEFV The second principle: In the vascular system, most of the circulating blood is in the veins The amount of blood in the arteries is small and the size of the arteries does not change much due to vascular tone in order to keep a fairly constant blood pressure Normal expansion of femoral vein (no fluid overload + no dehydration) METHOD Patients were enrolled and physical examination was recorded: • Fluid overload in the venous system: presence of rales in the lung and painful sensation with a minimal punch in the right lower rib cage (fluid in the liver) METHOD • Fluid overload in the extravascular system: fluid infiltration in the abdominal wall, edema at the ankle, thigh, dependent areas (e.g presacral area, etc) METHOD Low perfusion in the arterial compartment consists of • Low blood pressure • Cerebral hypo-perfusion (causing dizziness or change of mental status) • Renal perfusion (causing pre-renal azotemia (increased blood urea nitrogen) • Distal peripheral arterial system perfusion (causing fatigue or exercise intolerance) Location of fluid overload *Patients with more intravenous fluid overload  ACEI + BB + Short term fast acting loop diuretics (eg: furosamide) *Patients with more extravascular fluid overload  ACEI + BB + Long acting, lower dose diuretics (eg: HCTZ) RESULTS 50 patients were enrolled from January 2015 to April 2016 All came with shortness of breath and had a diagnosis of HF in the emergency room All the patients were diagnosed with HF with low or preserved EF  60% patients with long standing dilated cardiomyopathy had more extravascular fluid overload  Compared to only 30% patients of recent dilated cardiomyopathy RESULTS  The patients with new or recent onset of dilated cardiomyopathy recovered faster (within 24 hours) while the other patients took longer to recover  These latter patients also needed more medications CONCLUSION Based on the location of the fluid overload, the patients with new onset of HF were faster to recover with less times and lower need for resources REFERENCE • Thach Nguyen, Advait Soni, Chau BL Vien, Ryan Phan, Tung Mai “Differences of Presentations and Responses to Management of New Onset Heart Failure versus Long Standing Heart Failure.” ... patients also needed more medications CONCLUSION Based on the location of the fluid overload, the patients with new onset of HF were faster to recover with less times and lower need for resources... Expansion of the Femoral Vein test • The SEFV is the ultrasound study examining the size of the femoral vein and its expansion with cough • The ultrasound plane of the femoral artery and vein to be checked... faster to recover with less times and lower need for resources REFERENCE • Thach Nguyen, Advait Soni, Chau BL Vien, Ryan Phan, Tung Mai “Differences of Presentations and Responses to Management