ESC 2016 Guidelines: Acute Heart Failure

Professor Christian Müller

Disclosures

Swiss National Science Foundation

.

.

..

Research support / travel support / consulting fees

from several diagnostic and pharmaceutical

companies

Herzinsuffizienz

„Stauung“

„Dekompensation“

„AHF“

„Stabile Phase“

„kompensiert“

„chronische HF“

„kardiogener Schock“

„plötzlicher Herztod“

5 Jahre

AHF: Mortality

Owan T et al. N Engl J Med 2006;355:251-259

No

cardiogenic

shock!!

US

AHF: Interdisciplinary Care

Congestion

Decompensation

AHF

5-10 days

Ambulance

GP

FU

Mueller C, et al. EHJ-ACC 2016

M

m

Breidthardt T, et al. J Intern Med 2010;267:322-30.

Mmmmmmmmmmm

Mmmmmmmmmmm

mmmmmmmmmmmmmmmmm

Mmmmm

BNP/PCWP

We underestimate the severity of disease:

Objective Assessment of the Efficacy of current Therapy

Non-ICU Setting

ESC/HFA 2016 HF Guidelines

9

Echo

EKG: STEMI cTn

EKG: VT rapid Afib

Sepsis CRP, PCT

What is the key symptom in AHF?

What are the key diagnostic tools?

Symptoms & signs

ECG, Chest x-ray, BNP Echo

Acute dyspnea

Pathophysiology?

Intracardiac filling pressures

Pathophysiology

Mmmmmmmmmmmmmm

M

mmmm

Torem / Lasix

Nitrate

Vasodilators Or sublingual!!

Benefit from nitrates may depend on the AHF phenotype

Dyspnea ++++ +

Edema + ++++

Nitrates ++++ +

Sharon A et al. JACC 2000;36:832

Nitro:

MI ↓ (55% vs 10%)

Intubation ↓ (80% vs 20%)

Sharon A et al. JACC 2000;36:832

Cotter G, et al. Lancet 1998;351:389

GALACTIC:

Strategy vs Single drug

Maximal Preload/Afterload with Vasodilators

Target BPsys: 90-110 mmHg

BNP

PCWP, …

time 24h 48h 72h 96h 120h

Standard

Early Goal-Directed Treatment

GALACTIC:

Strategy vs single drug

1. Is it AHF?

2. Cardiac disease?

3. Trigger?

AHF: Diagnosis

History, physical, ECG

Chest x-ray, BNP✓

AHF ESC 2016 Guidelines

1. AHF braucht schnelle Diagnose + Therapie

2. Trigger! (Vofli, EKG; AMI, EKG+cTn; Sepsis, CRP/PCT,RöTh

3. Therapie: Lasix+Nitro + ACE-I, BB, Aldactone

4. Interdisziplinäre Patientenpfad mit Kardio FU