James Edwards does a two-part chat with Dr. Sean Lal. Sean’s clinical and research interests are in heart failure.
Summary Writer: Jane McDonnell
Script Writer: Kate Kearney Graham
Editor: Sean Lal
Interviewee: Sean Lal
In Part 1 we go through what heart failure is. You will learn what diastolic dysfunction is and why it causes heart failure. And we will also go through an example case.
In Part 2 we look at how best to investigate, what are the common precipitants, what type of drugs are used and when to escalate care.
Broadly speaking we have two types, heart failure with preserved ejection fraction (HFpEF) and with reduced ejection fraction (HFrEF).
HFrEF is systolic dysfunction of the left ventricle (LV).
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.
Sean Lal is a clinical academic cardiologist at Royal Prince Alfred Hospital and the University of Sydney in NSW, Australia. He undertook his training at the University of Sydney, Royal Prince Alfred Hospital and Harvard Medical School.
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.
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.
History
Examination
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evelyn
April 15, 2020 at 1:50 pmthanks for this post, very detailed and easy to learn
Ashish Singhal
October 1, 2020 at 4:59 pmFirst of all thanks for this wonderful content and make it easy for me to learn.