ESC 2016 Guidelines: Acute Heart Failure Professor Christian Müller
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ESC 2016 Guidelines: Acute Heart Failure
Professor Christian Müller
Disclosures
Swiss National Science Foundation
.
.
..
Research support / travel support / consulting fees
from several diagnostic and pharmaceutical
companies
Herzinsuffizienz
„Stauung“
„Dekompensation“
„AHF“
„Stabile Phase“
„kompensiert“
„chronische HF“
„kardiogener Schock“
„plötzlicher Herztod“
5 Jahre
AHF: Mortality
Owan T et al. N Engl J Med 2006;355:251-259
No
cardiogenic
shock!!
US
AHF: Interdisciplinary Care
Congestion
Decompensation
AHF
5-10 days
Ambulance
GP
FU
Mueller C, et al. EHJ-ACC 2016
M
m
Breidthardt T, et al. J Intern Med 2010;267:322-30.
Mmmmmmmmmmm
Mmmmmmmmmmm
mmmmmmmmmmmmmmmmm
Mmmmm
BNP/PCWP
We underestimate the severity of disease:
Objective Assessment of the Efficacy of current Therapy
Non-ICU Setting
ESC/HFA 2016 HF Guidelines
9
Echo
EKG: STEMI cTn
EKG: VT rapid Afib
Sepsis CRP, PCT
What is the key symptom in AHF?
What are the key diagnostic tools?
Symptoms & signs
ECG, Chest x-ray, BNP Echo
Acute dyspnea
Pathophysiology?
Intracardiac filling pressures
Pathophysiology
Mmmmmmmmmmmmmm
M
mmmm
Torem / Lasix
Nitrate
Vasodilators Or sublingual!!
Benefit from nitrates may depend on the AHF phenotype
Dyspnea ++++ +
Edema + ++++
Nitrates ++++ +
Sharon A et al. JACC 2000;36:832
Nitro:
MI ↓ (55% vs 10%)
Intubation ↓ (80% vs 20%)
Sharon A et al. JACC 2000;36:832
Cotter G, et al. Lancet 1998;351:389
GALACTIC:
Strategy vs Single drug
Maximal Preload/Afterload with Vasodilators
Target BPsys: 90-110 mmHg
BNP
PCWP, …
time 24h 48h 72h 96h 120h
Standard
Early Goal-Directed Treatment
GALACTIC:
Strategy vs single drug
1. Is it AHF?
2. Cardiac disease?
3. Trigger?
AHF: Diagnosis
History, physical, ECG
Chest x-ray, BNP✓
AHF ESC 2016 Guidelines
1. AHF braucht schnelle Diagnose + Therapie
2. Trigger! (Vofli, EKG; AMI, EKG+cTn; Sepsis, CRP/PCT,RöTh
3. Therapie: Lasix+Nitro + ACE-I, BB, Aldactone
4. Interdisziplinäre Patientenpfad mit Kardio FU
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