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Heart   Failure An overview
[object Object],[object Object],[object Object],Volume 1, Issue 1; May, 2008
OBJECTIVES ,[object Object],[object Object]
IS IT A PANDEMIC???
Number 1 Killer
5.7Million Americans
Mortality has more than   doubled   since 1979
>65years Leading cause of hospitalization
1-2%   of Health Care cost   $ 39.2 Billion
5  years from diagnosis  only  50%  alive
The Past
In 1950 first edition of  Harrison’s Principles of Internal Medicine D ecubitus D ietary sodium restriction D igitalis D iuretics (mercurial) Venesection and  Morphine The Management of Heart Failure: The Past, the Present, and the Future   Eugene Braunwald,MD   Circulation: Heart Failure. 2008;1:58-62
In 1970 Sixth edition of  Harrison’s Principles of Internal Medicine Diuretics ( Thiazide, Loop, Potassium sparing ) β-adrenergic agonist  Precipitating cause The Management of Heart Failure: The Past, the Present, and the Future Eugene Braunwald,MD   Circulation: Heart Failure. 2008;1:58-62
The Present
Level of Evidence LEVEL OF EVIDENCE C  A
ACE INHIBITORS or ARB BETA BLOCKERS DIURETICS DIGOXIN SPIRONOLACTONE OPT:  Optimal Pharmacologic Therapy ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult. 2001; 1-56. ADJUNCT: HYDRALAZINE and NITRATES
Copyright ©2008 American Heart Association Management of heart failure over the past 40 years Katz, A. M. Circ Heart Fail 2008;1:63-71
 
Biventricular pacing therapy ,[object Object],[object Object],[object Object],[object Object],(Strength of Evidence = A) http://www.heartfailureguideline.org   2010 Comprehensive Heart Failure Practice Guideline
Cardiac Resynchronization Therapy  Prolongs Survival in Patients With  Left Ventricular Dysfunction:  A Meta-Analysis ,[object Object]
[object Object],Percentage of Patients Free of Death from Any Cause or  Unplanned Hospitalization for Major Cardiovascular Event Percentage of Patients Free of Death from Any Cause Cleland JG et al.  N Engl J Med.  2005:352;1539 .
 
ICD Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],The  ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities
Left Ventricular Assist Devices (LVAD) The Jarvik-7 The Jarvik 2000   The World's First Artificial Heart
Indications ,[object Object],[object Object],[object Object]
Transcutaneous Ventricular Assist Device
Implantable Ventricular Assist Device
Ventricular Assist Device in the market HeartMate II® Arrow LionHeart   DeBakey LVAD   Thoratec CentriMag® Thoratec PVAD™ Thoratec IVAD™ HeartMate® XVE
Surgeries for heart failure
Coronary Revascularization
Valvular Surgery
Left Ventricular Reconstructive Surgery (Dor Procedure)
Batista Procedure
Cardiac Transplant At Groote Schuur Hospital  On December 3 rd  1967
Mr. Louis Washkansky lived for 18 days    Smithsonian‘s National Museum of American History
250,000 deaths per year Only 2000 donor hearts available
Never make predictions
Genetic Mutations
Insertion/deletion polymorphism within the  ACE  gene Polymorphism of   the adrenergic  α 2c receptor and of  the   β1   adrenergic receptor
CELL BASED THERAPY
 
PREVENTION
[object Object]

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Heart failure