HEART FAILURE SYNDROME“ KING FAHAD HOFUF CCU

EXPERIENCE”

DR ASADULLAH SOOMRO

Consultant cardiologistKing Fahad Hofuf HospitalKingdom Of Saudi Arabia

Email;hssbasadsoomro@gmail.com

HEART FAILURE AT CCU KING

FAHAD HOFUF HOSPITAL

TOTAL ADMISSIONS IN CCU“1.6.1425 to 30.5.1426”

780MEN

473

61%

WOMEN

307

39%

TOTAL HEART FAILURE ADMISSIONS IN CCU

272

35%

WOMENMEN

52% 48%

HEART FAILURE DEATHS32 = 64%

Total admissions= 780

Total deaths = 50 ( 6.4%)

Total heart failures = 272 ( 35 % )

Total heart failure deaths = 32 ( 64% )

Men = 17 ( 53% )

Women = 15 ( 47% )

> 65 Years = 22 ( 68% )

CAD Heart failure deaths = 20 ( 63 % )

HEART FAILURE DEATHSMonth

6.1425

7.1425

8.1425

9.1425

10.1425

11.1425

12.1425

1.1426

2.1426

3.1426

4.1426

5.1426

Total deaths= 50

HEART failure deaths= 32

6 4 = 67%No death

No death

5 2 = 40%8 4 = 50%

3 3 = 100%

3 2 = 67% 5 3 = 60%6 4 = 67%5 2 = 40%6 6 = 100%3 2 = 67%

MEN = 17

WOMEN = 15

> 65 Years= 22

68%

HEART FAILURE ADMISSIONS IN CCU

“Age Distribution”<45 YEARS

34

>65 YEARS

139 (51%)

46 – 64 YEARS

114 ( 42% )

HEART FAILURE

AUDIT

Total no = 115

ETIOLOGY OF HEART HAILURETotal number = 115

CADIOMYOPATHIES

20 = 17%OTHERS20 = 17%

ISCHEMIC

32 = 28%

HYPERTENSIVE

43 = 37%

ETIOLOGY OF HEART HAILURETotal number = 115

CAD 25 = 40 % 7 = 13.4 %

CARDIOMYOPATHIES 20 = 32% 0 = 0%

HYPERTENSION 10 = 16 % 33 = 63.4%

RHEUMATIC 5 = 8% 6 = 12%

MISCELLANOUS 3 = 5 % 6 = 12%

DISEASESystolic Dysfunction

EF < 50%PERSERVED Systolic Function

EF > 50%

AGE Distribution Total no = 115

Systolic dysfunction=63

< 65yrs= 32 =M 21,w 11

> 65yrs = 31= M 20,W 11

Age range= 17 to 90yrs

Men = 21 to 85 yrs

Women = 17 to 90 yrs

Average age Men= 59yrs

Average age Women = 61yrs

Perserved LV function= 52

< 65yrs= 26= M 12,W 14

> 65yrs= 26 = M 6 W 20

Age range =28 to 90yrs

Men = 28 to 80yrs

Women = 43 to 90yrs

Average age = Men= 60 yrs

Average age = women = 65 yrs

Heart Failure Hospitalization

Systolic dysfunction No =63

Ist time = 24 = 38%

Multiple time = 39 = 62 %

Men = 41 = 65 %

Multi time = 23 = 56%

Women = 22 = 35 %

Multi time = 16 = 73%

Perserved LVFunction No = 52

First time = 17 = 33%

Multiple time =35 67%

Men = 18 = 35%

Multi time = 8 = 23%

Women = 34 = 65%

Multi time =27 = 77%

Diabetes & Heart Failure

DM alone

79= 69%

DM+ HTN

70 = 61% NO,DM, HTN 36 = 31%

37 = 59%

32 = 51%

26 = 41%

42 = 81%

38 = 73%

10 = 19%

Comorbid Systolic CHF = 63 Perserved CHF = 52

Hypertension & Heart failureComorbid Systolic dysfunction=63 Perserved LVEF =52

Hypertension alone

86 = 75%HTN + DM

70 = 61%

NO HTN or DM

29 = 25%

41 = 65%

32 = 51%

22 = 35%

45 = 87% F= 67%

38 = 73% F = 74%

7 = 13.4%

Comorbidity & Lab results S3 Gallop = 53 = 46%

Blood Glucose >.8mm = 72 = 63%

Creatnine level > 125 = 29 = 25%

LFT = 18 = 16%

Wbc > 11,000 20 = 17 %

Hb < 10 gm 15 = 13%

Na < 130 6

K > 4.5 8

Stroke 8 = 7%

Hypothyroidism = 4

Intubated & ventilated = 21 18%

Systolic dysfunction

42 = 67%

40 = 63%

15 = 24%

16 = 25%

9 = 14%

6 = 10%

4

6

4

2

12 = 19%

Perserved LVEF

3 = 7%

32 = 62%

14 = 27%

2 = 4%

11 = 21%

9 = 17%

2

2

4

2

9 = 17%

ELECTROCARDIOGRAPHIC FINDINGS

A more cost effective approach to the diagnosis of suspected HF is to use the electrocardiogram as the initial investigation. If tracing is normal other diagnosis should be considered. common abnormalties in EKG are readily recognised. With this approach the number of echocardiogram could be

reduced by 50%.

ELECTROCARDIOGRAPHIC FINDINGSSystolic dysfunction

21 = 35%

21 = 35%

17 = 27%

14 = 22%

7 = 11%

0%

Perserved LVEF

7 = 14%

4 = 08%

13 = 25%

9 = 17%

16 = 16%

2 = 2%

EKG Changes

Q waves = 28= 24%

LBBB = 25 = 22%

A Fib = 30 = 26%

LVH = 23 = 20%

OTHERS = 23

Normal 2 = 2%98% had abnormal ECG

48% had Q or LBBB

CONCLUSIONThe electrocardiogram is a valuable first line

investigation for suspected chronic heart failure .A normal EKG virtually excludes CHF due to left ventricular systolic dysfunction.

An abnormal EKG does not mean that patient has CHF but is an indication for an echocardiogram .

Similarly S3 gallop frequently indicate that LV ejection fraction is less than 30%.

CONCLUSIONH.F is not a disease it self but a complex syndrome with

Heterogeneous etiology .

CAD remain most common cause of systolic heart F, where is hypertension in preserved LVEF. HF can cause frightening symptoms with multiple readmission especially in women.

Uncontrolled DM and hypertension seems to be most common precipitant in our patients followed by rapid A FIB.

• Echocardiogram is virtually a gold stander in diagnosis (reversible etiology ) and management of HF, however diagnosis of HF relies on clinical judgment based on history, thorough physical examination , 12 lead ECG and chest X-ray are still considered to be cost effective and highly significant at primary , secondary and even tertiary care centers.

CONCLUSION