Summary Writer: Jane McDonnell
Script Writer: Kate Kearney Graham
Editor: Sean Lal
Interviewee: Sean Lal
James Edwards chats to Dr Sean Lal about heart failure.
Sean Lal is a clinical academic cardiologist at Royal Prince Alfred Hospital and the University of Sydney, NSW, Australia. He undertook his training at the University of Sydney, Royal Prince Alfred Hospital and Harvard Medical School. Sean’s clinical and research interests are in heart failure.
With Dr Sean Lal, Clinical Academic Cardiologist at the University of Sydney and Royal Prince Alfred Hospital, New South Wales, Australia
It is easiest to consider heart failure broadly as heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). HFrEF is systolic dysfunction of the left ventricle (LV). We commonly use a cut off of ejection fraction (EF) <50%. We regard EF 40-50% as mild systolic impairment and EF <40% significant systolic impairment.
HFpEF (where EF ³50%) is becoming increasingly more common. In such a setting, the LV is stiff and non-compliant and there is diastolic dysfunction so the LV doesn’t fill as easily. The classic example is a patient with LV hypertrophy (LVH), for example in the setting of aortic stenosis, with comorbidities such as hypertension, obesity and diabetes. This is a common cluster of symptoms in the community. When a patient presents with symptoms of heart failure (e.g. shortness of breath) but have a normal EF, look for echocardiogram features of diastolic dysfunction.
The most common cause of right heart failure is left heart failure.
Case 1 – You are asked to see a 60 year old man who is admitted under respiratory with symptoms of an upper respiratory tract infection (URTI) and shortness of breath. On history, you note he has had some difficulty waking up, shortness of breath at night and some trouble walking upstairs. He is a non-smoker. He has been admitted for intravenous (IV) antibiotics and fluids. You are consulted to see the patient for shortness of breath.
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