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
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
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
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
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
09:30 – 09:45 am
09:45 – 10:00 am
Dr. Ahmed Yahya Alarhabi, MSC,FCUSM,FACC,MAHA
Consultant Interventional Cardiologist
University of science and Technology Hospital
Management of chronic HF (clinical practice)
Role of anti-coagulation in HF
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:
- Fahmi Alhakimi
- Dr.Maged Amer
- Dr.Ahmed Alarhabi
- Dr.Abdulqawi Almohamadi
- Ahmed alamri
- Ahmed burjomi
- Mohammed Aldahri
- 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
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
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 .
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
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
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