Heart Failure Symposium Day

Heart Failure Symposium Day

University of science and technology Hospital

20 August 2015

Speech of The President of the UST

 Dear honorable guests, colleagues, members and everyone,
It’s my great honor to welcome all of you at the platform of the University of Science and Technology Hospital, the host institution of this symposium which addresses heart failure as one of the scientific and medical activities organized by the university-hospital.
Taking covenant before Allah, the university and its hospital will continue doing their responsibility and put all its scientific, administrative, and financial potentials at the service of the society despite the exceptional circumstances experiencing the country. Today's symposium is a typical example and one of the effective contributions that the university always performs so as to give hope and spirit to the society

Speech of University of science & technology hospital

       ( Listen to speech )
It is my pleasure to cordially welcome everybody in this symposium. On behalf of UST Hospital administration, I would like to thank all the supporters, workers in this scientific symposium. Though it comes in an inconvenient time, it will play in important role in educating the society around us. Our job as a Hospital management is to seek to hold such symposiums and conferences in a hope that they will have an impact on our society. Furthermore, Yemen is passing in a critical situation and needs such educating and awareness-raising events to help people protect themselves against any negative effects. I also hope that the results of this symposium will be reflected on our daily dealings and behaviours. Again, I want to say thanks a lot for all those participating in preparing and holding this Heart Failure Symposium hopefully to meet you in the coming symposiums.

Speech of Head of Symposium

Dr. Ahmed Yahya Alarhabi, MSC,FCUSM,FACC,MAHA
Consultant Interventional Cardiologist
University of science and Technology Hospital

Dream turn a Real
This was the triggering of our symposium, during one conversation with my brother and colleague Dr. Noralldin Aljaber when we are discussing a case. I still remember when Dr. Aljaber said can we do a scientific meeting and activity its my dream.
Today I would like to tell him your dream turn a real and we with all of our colleague make it.
Thank you very much for all of those support this symposium , which carried on a very difficult current situation. I hope this activity can improve the attitude of all participant toward their patients

Speech of Head of Scientific committee

Dr. Abdulkhaliq Annonu, MD
Senior Consultant of Intervention Cardiology
On behalf of the "Heart Failure Symposium Day" Scientific committee. It is a pleasure to welcome all participants, especially the junior cardiologists, general practitioners, and doctors whom are recently graduated; whom they are our target in this symposium. Our aim is to reactivate the continuous medical education, in order to refresh our medical knowledge.
Heart failure (HF) is a global public health problem affecting an estimated 26 million worldwide.
Despite the absence of statical data of HF incidence and prevalence in Yemen, there are increase in HF rates which poses high economic and social burden. Therefore, prevention of HF deserves high priority as well as its detection and management

Scientific committee:

1. Dr. Abdulkhaliq Annonu
2. Dr.Maged Amer
3. Dr. Ahmed Alarhabi
4. Dr. Nouradden Al-Jaber
5. Dr. Salah Shawki
6. Dr.Sami zaid
7. Dr. Mohammed Alhosami
8. Dr.Abdulqawi Almohamadi
9. Ahmed burjomi

Organizing Committee:

1. Fahmi Alhakimi
2. Dr.Maged Amer 
3. Dr.Ahmed Alarhabi
4. Dr.Abdulqawi Almohamadi
5. Ahmed alamri 
6. Ahmed burjomi
7. Mohammed Aldahri 
8. Kamal shamsan

Time Schedule of the Symposium 

 

 

 

Abstracts

 

Pathophysiology of heart failure    lecture 

Dr. A.Karim M.Hajar

MSC. M.D   associate prof. Sana'a university       

 09:30 – 09:45 am

Myocardial injury by different etiology factors determines a reduction in cardiac performance with cosequent activation of a series of neurohumoral factors that have the task to restore adequate hemodynamic values .

This mechanism involves progressive cardiac remodeling which in turn increase damage and progressive worsening of lv function.

Also i discussed the role of the adrenergic system in hf.

Initially cardiac remodelling is an adaptive process which helps to restore adequate output but by the time this is transformed in a negative phenomenon with the development of hf.

Also in my lecture i talked important definitions as, preload, afterload, stroke volume , cardiac output etc to help understanding the pathophysiology of HD

Approach to HF patient         lecture 

Dr. Nouradden Al-Jaber, MBBS, M.Sc., MD. Associate prof. of internal medicine and cardiology -Sana’a University. Consultant cardiologist in cardiac center at Althawra MGH. Sana,a Head of Non-Invasive Cardiac Unit. Althawra MGH. Sana’a

09:45 – 10:00 am

Heart failure consider the most common reason for hospitalization in adults >65 years old. 

Heart failure- clinical syndrome … can result from any structural or functional cardiac disorder that impairs ability of ventricle to fill with or eject blood to all body systems. The impact of heart failure in the world is so significant, around 5 million americans- have heart failure , 500,000 new cases every year , 25-50 billion dollars a year to care for people with hf , 6,500,000 hospital days / year and 300,000 deaths/year the keys to understanding hf is the fact that, all organs (liver, lungs, legs, etc.) Return blood to heart, when heart begins to fail ,that lead to inability to pump blood forward & fluid backs up lead to pressure within all organs. The organ response starts, like the pulmonary congestion, low cardiac output & systemic congestion, etc. The main objectives of this review talk is how to understand the approach to the heart failure patient , through the proper diagnosis , taking the medical model as guide , and how to stage the heart & to classify the heart failure , which stage to which type of patient. 

This presentation will focus on the following:-

1-introduction to history of heart failure. 

2-the clinical data of heart failure 

3-the way to investigate heart failure patient. 

4-what are the concomitant diseases we should think about. 

5-the classes of heart failure. 

6-the stages of heart failure. 

7-final conclusion. 

 

Acute decompensated heart failure     lecture 

Dr. Ahmed Yahya Alarhabi, MSC,FCUSM,FACC,MAHA             
Consultant Interventional Cardiologist
University of science and Technology Hospital

Acute decompensated heart failure (ADHF), an exacerbation of chronic cardiac, pulmonary, and/or renal dysfunction, accounts for most of the highly economic cost spent on chronic heart failure. 

The condition is caused by severe congestion of multiple organs by fluid that is inadequately circulated by the failing heart. An attack of decompensation can be caused by underlying medical illness, such as myocardial infarction, infection, or thyroid disease 

The pharmacotherapy of ADHF has not changed recently, but studies have indicated that most therapy is efficaciously, though not economically, equivalent. Evidence-based, inpatient pharmacotherapy is guided by understanding of the forrester hemodynamic subsets and their pathophysiology. Clinical success is dependent not only upon proper inpatient treatment, but also upon the utilization of a discharge team. Pharmacists can bridge the gap between hospital visits and outpatient care by recommending and providing continuity of care.

Update in cardiogenic shock management   lecture 

Dr. Ibrahim dom                                                    

10:15 – 10:30 am

Cardiogenic shock is most commonly results from acute mi or any acute lv,rv dysfunction. Cardiogenic shock is life-threaten with mortality rate range from 40-50%.

Management of cardiogenic shock complicate acute mi without mechanical complications is emergent revascularization by: fibrinolysis , fibrinolysis plus pci, pci alone ,or surgical intervention.

Medical treatment is to be concerned as primary adjunctive therapy to stabilize the patient and to facilitate emergent revascularization. Therapy generally begun with vasopressors, although dopamine is frequently chosen before noradrenaline, there is some evidence to suggests the latter is less arrhythmogenic.

Unfortunately, use of any inotropic support may lead to increase myocardial o2 consumption and results in more arrhythmogensis and decrease cardiac performance.

In drug –refractory cardiogenic shock , mechanical actions include intra-aortic balloon counter- pulsation , percotaneous lv assist devices , and e.c.m.o.

Most mechanical complications such as amr , vsd and wall rupture occur within the 24 hours of acute mi .

Management of cardiogenic shock from these complications involve emergent surgical intervention and the mortality rate range from 20 -90% depend on the type of complications & the time chosen for intervention.

Management of chronic HF (clinical practice)    lecture 

Dr. Salah al shawki, MD 

Assistant professor of cardiology                                       

Consultant of cardiology & cardiac catheterization 

10:30 -10:45 am

In this presentation, the management of chronic heart failure (chf) based on the most recent guidelines..

In treating a patient with chf, we choose drugs based upon their ability to achieve:

1. Relieve symptoms

2. Prevent hospitalization

3. Improved survival..

Per recent esc guideline, for managing patients with chf according to ef% level. Patients with reduced ef less than 40%, most of these patients have volume overload, so the first step to relieve symptoms by diuretics. The 1st line therapy in these patients include beta blockers and acei/arbs. If the patient is still symptomatic, spironolactone is the next step if ef less than35%..

If still symptomatic, ivabradine can be added if ef less 35%. Ivabradine improved quality of life and lv function and also deceased cardiovascular death. If still symptomatic, we can go for digoxin.

Symptomatic pts despite optimal medical treatment, with wide qrs complex and ef less 35% are indicated for cardiac resyncoronization therapy (crt).

In this presentation, each of these drugs will be discussed with special emphasis on: indications/contraindications and some clues for daily practice..

Finally, does it matter who goes first? Bb or ace inhibitors. The answer is: you can start by any one: bb followed by acei or acei followed by BB.

Role of anti-coagulation in HF        lecture 

Dr. Mohammed Abdullah kubas               

M.SC. Clinical pharmacy 

Clinical pharmacist specialist, university of science & technology hospital (usth), sana’a, yemen. 

Lecturer (part time), faculty of pharmacy, university of science & technology (ust), sana’a, yemen. 

10:45 -11:00 am

Heart failure is a common clinical condition associated with high morbidity and mortality rate despite significant improvements in pharmacotherapy and implementation of medical procedures. Patients with heart failure are at an increased risk of developing arterial and venous thrombosis, which contribute to the high rate of adverse events and fatal outcomes. Many heart failure patients routinely receive antithrombotic therapy due to the presence of a specific indication for its use, like ischemic heart disease or atrial fibrillation. However, there is no solid evidence to support the routine use of antithrombotic agents in all heart failure patients. This lecture will review the evidence for using antithrombotic therapy in heart failure patients.

Systemic complications of HF         lecture 

Dr. Mohammed alhosami,

MD internal medicine
assisted prof.of medicine in university of science and technology .

11:00 -11:15 am

Many systems are affected by heart failure either by systemic congestion, stasis or through production of certain cytokines. 

Another mechanism of systemic affection is decrease blood flow to organs of the body 

The end results of systemic affection are failure of certain organs to do their functions like the liver,kidneys and intestine. 

There are another complications occurring do to certain structural changes occurring in heart failure in the form of systemic embolization‏ another very important systemic complication of heart failure is cardiac cachexia 

We are focusing in our topics on clinical systemic complications of heart failure as we mention and paraclical systemic complications of heart failure like hypokalaemia and hyponatraemia 

Interventional management of HF         lecture 

Dr. Abdulkhaliq annonu, MD

Senior consultant of intervention cardiology

11:30 – 11:45 am

This presentation will summarize the current procedures, done in catheter lab, that help patients with hf.pci is the most procedure done for patients with ihd to prevent or treat hf. 

ICD placement

 Results in remarkable reductions in sudden death from ischemic and nonischemic sustained ventricular tachyarrhythmias in hf patients. 

Patients with heart failure and interventricular conduction abnormalities are potential candidates for crt to improve cardiac performance by restoring the heart's mechanical synchrony. 

Percutaneous aortic balloon valvuloplasty is a class iib therapeutic option as a bridge to surgical avr or tavr. Severe rheumatic ms is common in yemen and considered a critical form of hfpef. Mitral balloon valvuloplasty has become a mainstay in the management of rheumatic ms. Transcatheter mv clip repair is now an approved device for patients with degenerative forms of mr in whom the risk associated with surgical valve repair or replacement is high. 

Implantable monitoring devices are under investigation. These devices allow continuous or intermittent assessment of intracardiac hemodynamics. 

Some temporary percutaneous ventricular assist device like tandem heart can be inserted by cardiologists in cath lab. It has been used for patient with transient severe hf or postcardiotomy cardiogenic shock as a bridge to a definitive therapy.

Anesthesia of HF patient             lecture 

Dr. Sami ziad, MD anesthesiologist

Assisted prof. Of anaesth. & intensive care ust

Head of anesthesia dep.,  ust hospital

11:45 -12:00 am

Patients with decompensated heart failure should have all non-emergent operations postponed – the cause of decompensation should be determined, and the patient should not return to the operating room until two weeks after symptoms have resolved. 

Heart failure (HF) is a risk factor for cardiac complications after noncardiac surgery. After major surgery, chronic stable hf is associated with two- to threefold higher 30-day mortality and hospital readmission compared with coronary artery disease. 

Minor procedures are also associated with somewhat increased morbidity and mortality in patients with chronic stableHF. 

Patients with new-onset, worsening, or acute decompensated HF are at particularly high risk for perioperative morbidity and mortality. This topic will discuss anesthetic management of patients with chronic HF undergoing elective noncardiac surgery, as well as the anesthetic management of patients with acute decompensated hf undergoing urgent or emergent surgery

Stress induced cardiomyopathy (takotsubo)          lecture 

Dr. Ahmed Yahya Alarhabi, MSC,FCUSM,FACC,MAHA
Consultant Interventional Cardiologist
University of science and Technology Hospital

12:00 – 12:15 pm

When abrupt and unpredicted chest pain and often shortness of breath occurred in previously healthy individual and that symptoms triggered by emotional and physical stressful events we should think about takotsubo cardiomyopathy.

Although its occurred in normal coronary arteries, but the typical chest pain concede with electrocardiographic changes and elevated cardiac markers the need of coronary angiogram in mandatory to exclude the concomitant coronary artery disease.

Management still the same like all types of cardiomyopathy plus psychotherapy.

Prognosis is good if the patient can overcome the initial episode and complete recovery usually occurs within several weeks of the initial occurrence.

Surgical options for the treatment of heart failure    lecture 

Dr. Yahya rajah PhD

Consultant cardio-vascular surgeon

Military cardiac center

Sana'a – Yemen

12:15 – 12:30 pm

The surgical options for treatment patients with end-stage heart failure are currently limited. At this article we review the recent advances in the surgical management of refractory heart failure. Currently available surgical options include heart transplant, coronary artery bypass, mitral repair, ventricular restoration devices, cellular and stem cell therapy. Thorough review of evidence and available data on the benefits and risks of these therapies and procedures we present experts recommendations and clinical practice guidelines that assist surgeons in selecting the best surgical management strategy for an individual patient.

Cardio-renal syndrome, from theory to real practice    lecture 

Dr.shafiq. A.alimad, MD

Nephrologist. University of science and technology hospital. Sana'a. Yemen

12:30 – 12:45 pm 

Kidneys have a pivotal role in maintaining our homeostasis. Kidneys and heart work in tandem to maintain volume homeostasis. Heart failure impacts renal function in many ways including renal hypo perfusion but also due to increased venous pressure along with stimulation of various neuro-humoral responses. Renal failure induces cardiac damage and dysfunction by causing volume overload, inflammation and cardiomyocyte fibrosis. Concomitant comorbidities like hypertension and diabetes also play important role resulting in cardiorenal syndrome (crs). Acute dialysis quality initiative, 2007 recognized the bidirectional nature and different manifestations of crs in acute and chronic settings. 

Diuretics are the most common drugs to treat the most common of crs i.e., peripheral edema and pulmonary congestion. Diuretics could nevertheless contribute to worsening renal function (wrf). 

Initially it was accepted that wrf during the course of treatment of acute decompensated heart failure (adhf) uniformly resulted in worse prognosis. 

However, in view of a few recent studies, the significance of wrf early in response to treatment of adhf is being debated. 

The optimal dose and method of delivery of diuretics is still undecided. 

Isolated ultrafiltration does not improve renal function in patients with crs despite the early promise. 

A large, multicentre trial ruled out any survival benefits with recombinant brain natriuretic peptide (nesiritide). Despite good physiological basis and early promise with smaller studies, many drugs like dobutamine, rolofylline and tolvaptan failed to show survival benefit in larger studies. However, two recent studies involving relaxin and neprilysin have shown good survival advantage. 

This review will highlight update on crs with the most important clinical practical approach to this common entity . 

Keywords: acute decompensated heart failure (adhf), acute dialysis quality initiative (adq),worsening renal function(wrf),cardiorenal syndrome(crs).

Guidelines of HF what’s new        lecture 

Dr:dhaifullah jayed

Mbbs, msc, ph.d

Ass. Prof of cardiology

Senior consultant cardiologist

12:45 -13:00 pm

 Heart failure is a major and growing public health problem throughout whole word. Its incidence approaches 10 per 1000 population after age 65. 

The American college of cardiology foundation and the American heart association have jointly developed guidelines in the area of cardiovascular disease since 1980. Our review weight the strength of evidence for or against particular tests, treatments, or procedures; and include estimates of expected outcomes where such data exist. The class of recommendation (cor) is an estimate of the size of the treatment effect considering risks versus benefits in addition to evidence and /or agreement to that a given treatment or procedure is or is not useful /effective or in some situations may cause harm. 

The level of evidence (LOE) is an estimate of the certainty or precision of the treatment effect. 

The present review includes updates in recommendations, values, and preferences and medical tips to assist the medical practitioners manage their patients with heart failure.

  

By:- Dr.Abdulqawi Qaid Almohamadi