Heart Failure (Acute Decompensated Heart Failure)
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- Опубликовано: 29 сен 2024
- An overview of the etiologies, classification (wet vs. dry / warm vs. cold), and treatment of acute decompensated heart failure. (I'm sorry, but this is the one video of the Intern Crash Course series that's going to be over 10 minutes - heart failure is just too large a topic to shorten that much!)
For additional reading:
Antohi EL, et al. Therapeutic Advances in the Management of Acute Decompensated Heart Failure. Am J Ther; 2019 (www.ncbi.nlm.n...)
Kurmani S, et al. Acute Heart Failure: Definition, Classification and Epidemiology. Curr Heart Fail Rep; 2017 (www.ncbi.nlm.n...)
Evaluation and Management of
Patients with Acute Decompensated Heart Failure. Journal of Cardiac Failure; 2010 (www.hfsa.org/w...)
Heart image used in thumbnail courtesy of Patrick Lynch. Provided under CC BY 2.5. Downloaded from Wikimedia Commons July 2019.
I do the same in all his videos. Hit like before i have even started seeing it. All your videos and approach to different conditions is very clinically practical. I am massively benefiting from your videos as a new intern. Many Thanks Eric!!
Drugs with Mortality benefit in Heart Failure with reduced Ejection fraction are
1. ARNIs/ACEI/ARBs
2. Beta blockers
3. Spironolactone
4. Hydralazine/Nitrate
5. Ivabradine
6. SGLT2 Inhibitors
Yes, though one should remember that these have mortality benefit in chronic heart failure, not necessarily in the management of acute decompensated heart failure.
@@StrongMed that's true
@@StrongMed precisely
I really appreciate the effort you do into making these videos! You are really good at breaking complex topics into manageable, understandable bitesize nuggets of knowledge. Grateful for your time!
This is so helpful. Thank you very much.
This is amazing, Thank you so much!! HUGE fan.
Thank you Dr. Strong! In the patient presentation, does inotropy refer only to positive inotropes (since B blockers are included in the neurohormonal blockade section)?
Yes. Unless otherwise specified, "inotropes" refers just to medications which increase inotropy.
GREAT SIR
ONE Question please to YOU DOCTOR AND THOSE WITH GOOD HEART KNOWLEDGE. Thank you all very much.
I was born with a tiny heart soplo. Which was noticed 6yrs ago at age 28. I was told it was nothing to worry about becaue it was a very small size. I was on absolute bed rest at age 30 and my baby was at high risk. In btw I wasn't given any anticuaglants for 3 months. After baby was born. I got a mild pulmonary Trombos. I was placed on Back to my normal life etc.while on XARELTO for 1yr. I was adviced by 3 diff doctors to operate the soplo to avoid stoke for future pregnancies, other 4 diff doctors said it wasn't necessary and placed me on aspirin protect... says every one above 30 is supposed to be taking it. My breathing. ECO results, lifestyle have being normal. I DON'T SMOKE. The aspirin is provoking colitis and I am very scared about the operation, I don't want complications and I hope for more kids. How serious is this case? I have being traumatized with this fear for years now. PLS YOUR SINCERE HELP AND FEEDBACK WILL BE VERY VERY APPRECIATED. Thanks and God bless.
I'm truly very sorry, but I can't offer individualized medical advice on here.
x1.25 speed makes him almost sound like he's talking normally. You're welcome.
Sorry about the speed. Personally, for this video, I'd listen to myself at 1.5x 😉
I have congestive heart failure and take no medication for it because I stopped, My heart is gonna get worse and I can't wait till it happens, The pharmacist will never see my face again, The cardiologist will never see my face again.
Hey man, obviously I don't know you or anything about your situation, but if you need to talk to someone about how you are feeling, you can reach the national crisis hotline by calling 988 from any phone in the US. Death from uncontrolled heart failure may not be a comfortable way to go. I can't give specific, individualized medical advice here, but at the very least, I strongly recommend that you let your doctor know what you've decided to do. If it's a decision not from depression, but rather because you are suffering from a terminal illness, there are specific docs who practice something called palliative care or palliative medicine who can make the dying process as comfortable and well supported as possible.
@@StrongMed Nah, ive dealt with this long enough, If its painful then so be it, But my days of medicine, ekgs, blood work, cardiologist visits and whatever goes with it are completely over. Thank you.
@@JayDogTitan-he6wo how are you doing now? Ive met a few people that are symptom free years after stopping their meds
A bit curious about your health status now sir, I hope everything is ok
😊😍😍
Dear Eric,
I was recently criticised by a cardiologist for following NT-proBNP values as a prognostic marker. He cited this was not useful and very expensive. Could you reference the literature you're referring to?
Kind regard and thanks for another brilliant instructional video.
Thanks for the comment and question!
I appreciate that some people may not see the use of BNP (or NT-proBNP) as a "cost-effective" prognostic marker, but that would be because of its relative cost, not because it's not useful. Thus, it may not be as appropriate in resource-low locations where cost is an unusually high concern. But in the US (unless someone is paying out of pocket), there are many things we routinely do in the hospital that are more expensive and of smaller benefit (e.g. daily CBCs in clinically stable patients with a low probability of a hematological problem would near the top of my list).
Some references on BNP as a prognostic marker:
Use of BNP as an independent predictor of in-hospital mortality in ADHF: reference.medscape.com/medline/abstract/17498579
Use of NT-proBNP as an independent predictor of in-hospital mortality and length of stay: journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0207118
Use of serial and/or day-of-discharge BNP measurements as a predictor of 30 day readmission for heart failure: www.ncbi.nlm.nih.gov/pmc/articles/PMC4309072/
This is just great, an incredibly well constructed video on a massive topic. Thank you so much! One can only imagine how many patients worldwide are positively impacted because of your videos.
How to present the patient treatment plan at the end was such a wonderful and practical way how to teach medicine that it left me in awe. Huge thanks!
Great video doc. Thanks a lot!
Any reference for which type of exacerbation leads to what type of ADHF with pathophysiology ?
Strong is a really nice part of Stanford. Not a fan of everything that school does but they do have some Strong Medicine
Thank you so much for your detailed explanation.
It is extremely helpful as a nurse to understand the reasons behind the physician's decision.
Thank you so much for your great work.
Great and helpful info, especially the last part with the example of report. Thank you, Dr Strong!
I sincerely love you and thanks for letting us be your overseas students
Is a well compensated hear failure („dry and warm“) actually an „acute decompensated heart failure“ and not rather just a chronic heart failure?
They shouldn’t have any acute symptoms or am I wrong???
You are a legend sir, I wish I watched this lecture before today, but after today I will not make the same mistakes again, I promise.
Keep up the Strong work
Hello Dr. Eric. Do you also consider Neprilysin+ARB Combination to your hospitalised HFrEF patients after ADHF?
I'm so sorry - I'm just seeing your question now! The short answer is that I consider it, but I wouldn't say it's a go-to drug for me at the moment. I think Novartis has done a remarkable job marketing sacubitril/valsartan, but that the PARADIGM-HF trial (the major evidence used in the FDA's approval of the drug in the US) had significant enough limitations that I am less convinced by the magnitude of its benefit compared to some of my colleagues. I'm not saying I'm right and others are wrong, but I generally have a skeptical approach to the medical literature, and I am relatively cautious when new therapies become available. History has shown that medicine is far too rife with "medical reversals".
I've really been enjoying these recent videos. Thanks for all the hard work you've put in!
Thank you Doctor
And I've i Question please answer me
Acute Heart failure Patient with shortness of breath(SOB) and peripheral edema, which forrester classification?
• A. dry and cold
• B. wet and cold
• c. dry and warm
• D. wet and warm Stage
Which one is the correct answer ?
There is not enough information. Both B (wet and cold) and D (wet and warm) can present with shortness of breath and peripheral edema.
@@StrongMed i appreciate you answered me,This question was included in my exam , and I answered that it was cold and wet , because one of the symptoms of a hypoperfusion (decrease in cardiac output ) is shortness of the breath and that's why.
And idk if it's a true or false
This is great! Thank you! From a resident in sweden. Could you provide me with some article on the conversion between IV furosemid and oral furosemide?
Hi Dr. Strong,
Thank you for these great videos! I am a little confused about the treatment of warm/wet pts. You mentioned that loop diuretics would improve preload and vasodilators would improve afterload. Why does treatment of warm/wet pts focus on improving cardiac function when cardiac output is normal?
Thanks again.
Let this warm patient be more warmer. ☺️ Because heart function is not good here at all. Otherwise it wouldn't be heart failure .
Feeling warm does not mean patient heart is function is normal . ☺️☺️☺️.
Sameway heart failur pt may have SBP 110or 120. It is neither ur moniter nor your hand going to 100% judge tissue hypoperfusion. You must be able to judge heart failure from patient situation (sob, fatigue,lethargic...).😊😊Defination of heart failure involve term of CLINICAL SYNDROME and tissue hypoperfusion and not of particular BP or feeling hot or cold or feeling wet or dry . ☺️☺️☺️ Sob and with wet lung could just be a pnemonia too...if u hav still difficulty to understand HF ,i refer u a video, decription is on second reply..😉😉😉😉
Great resource.Thanks
Simply excellent. Very grateful for clear, concise and well presented video. Thank you for the great channel. 😊😊 9/9/2019
Thank you Doctor Strong. No salt restriction , I like to eat salt , :). This is a wonderful lecture indeed. Would you suggest the dose of hydra lazing and nitrate since you said it is better in acute situation than ACE I and ARB
Truly excellent & immensely appreciated. We are really indebted to you.
Thank you very much Doctor Strong. So practical.
Thank you so much! Pls make more videos like this!!
Your lectures are sooooo helpful. Big thanks 👍👍
The Presentation on texts is blurred to read it.
Perfectly and in proper way of explanation 🙏 excellent
"Intern"?? lol i haven't even taken the hesi yet
Thanx sir for your lectures....God bless you
Doctor, can you please make a teaching video lesson on Chronic Heart failure management.
Thank you for the suggestion - it's on my list of topics to cover!
Excellent approach to HF for any one in IM rotation .Thank you .
Great video. Thanks for your effort.
Understansing at its best!! Thanks a lot sir!!!
Hi dear Eric .. does de novo acute heart failure share the same traitement principles ?
Yes.
Pls doc make videos on echo ...
Iam so Thankful
Amazing video, thank you!!
Great video as always sensei Dr Strong ! Thank you !
You are great
So so good !!
First of all thank you for this lecture, very informative, and high yield in inpatient care.
Regarding the beta blockers it's always controversial where I work each attending has his own practice.
But I came to understand that if the patient was on a betablocker and compliance is assured then it should be continued and not held or reduced during the admission regardless of the severity of the CHF. ( unless the patient is HD unstable from hypotension/bradycardia)
Can you please guide from which reference you came with reducing or holding a betablocker if patient has mod/severe CHF?
That will help a lot. Thanks in advance.
MythoVirus if volume overloaded and symptomatic acute heart failure or acute on chronic try to avoid beta blocker in acute care
@@badharis4u yeah exactly ...in volume overloaded state b.blockers will lead to further exacerbation of overloaded symptoms.
💞💞💞💞
Love this video, thank you!!!
The music!! Lol
Great video. Can you do primer on dialysis, types and indications.Really appreciate your videos!