Today's case was an interesting presentation of a 51 year old Korean male presenting with new onset congestive heart failure. In this case, dialted cardiomyopathy was diagnosed and untreated hypertension was felt to be the most likely cause. The significant elevation in liver enzymes in this case was striking, somewhat above what would be expected with congestive hepatopathy. This Cleveland Clinic Journal review article has a nice summary of the differential and workup of this disease.
An interesting historical footnote is an outbreak of cardiomyopathy in Canada and the US Midwest associated with cobalt containing beer. Cobalt had been added to certain brands of beer as a foam stabilizer and was felt to be non-toxic. Apparently they did not consider the "volume" consumed by certain Canucks and Midwesterners, especially during hockey season... This was favorite challenge bowl fodder where I trained.
As for heart failure management in general, the ACP In the Clinic series has an excellent review of the topic linked here. The In The Clinic site also have slide sets of their topics that you can use for teaching interns / students / etc. Make use of it!
Review of topics covered in morning report, M&m, and core conferences with links to supplemental reading material.
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Showing posts with label CHF. Show all posts
Showing posts with label CHF. Show all posts
Friday, March 12, 2010
Friday, February 5, 2010
5 Feb - CHF/Afib
Todays discussion centered on management of CHF/A-fib management issues.
One discussion concerned the CAFE-II (NEJM Jun 19, 2008) study . Despite the fact that atrial fibrillation is poorly tolerated in heart failure patients, working to restore sinus rhythm did not improve outcomes compared to rate control alone.
http://content.nejm.org/cgi/content/abstract/358/25/2667
A Lancet article 11 Aug 2007 published results of the BAFTA trial analyzing the use of warfarin in elderly patients with atrial fibrillation. 20% of study subjects were >85 years old, and in all subsets the benefit appeared to outweigh the harm. You can get full text Lancet access through science direct in the hopsital.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-4PCSC5S-12&_user=2763990&_coverDate=08%2F17%2F2007&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000058752&_version=1&_urlVersion=0&_userid=2763990&md5=b766d43281583dd9944244e897cf5559
Also, be sure to remember the CHADS-2 score:
CHF, Age >75, HTN, and diabetes 1 point each, with 2 points for prior stroke or TIA. 3 points is a roughly 6% stroke rate per year and goes up with each additional risk factor. Handy on-line tool linked below.
http://www.mdcalc.com/chads2-score-for-atrial-fibrillation-stroke-risk
One discussion concerned the CAFE-II (NEJM Jun 19, 2008) study . Despite the fact that atrial fibrillation is poorly tolerated in heart failure patients, working to restore sinus rhythm did not improve outcomes compared to rate control alone.
http://content.nejm.org/cgi/content/abstract/358/25/2667
A Lancet article 11 Aug 2007 published results of the BAFTA trial analyzing the use of warfarin in elderly patients with atrial fibrillation. 20% of study subjects were >85 years old, and in all subsets the benefit appeared to outweigh the harm. You can get full text Lancet access through science direct in the hopsital.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T1B-4PCSC5S-12&_user=2763990&_coverDate=08%2F17%2F2007&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000058752&_version=1&_urlVersion=0&_userid=2763990&md5=b766d43281583dd9944244e897cf5559
Also, be sure to remember the CHADS-2 score:
CHF, Age >75, HTN, and diabetes 1 point each, with 2 points for prior stroke or TIA. 3 points is a roughly 6% stroke rate per year and goes up with each additional risk factor. Handy on-line tool linked below.
http://www.mdcalc.com/chads2-score-for-atrial-fibrillation-stroke-risk
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