Medical treatment of chronic heart failure

Agnès Pasquet, Anne Catherine Pouleur Published in the journal : February 2022 Category : Cardiology

During the year 2021, the European Society of Cardiology published new recommendations for the management of patients with chronic heart failure (1). Classically, patients with heart failure have previously been categorized according to the left ventricular ejection fraction (LVEF). Three different groups are currently recognized:

- Patients with reduced LVEF defined as LVEF ≤40%, which is referred to as heart failure with reduced Ejection Fraction).

- Patients with LVEF between 41% and 49%, i.e,. slightly reduced, which is referred to as heart failure with mildly reduced ejection fraction or HFrEF.

- Patients with signs or symptoms of heart failure with structural or functional cardiac abnormalities or elevated natriuretic peptides and an LVEF >50%, which is referred to as heart failure with preserved ejection fraction or HFpEF.

This article has reviewed the principles of pharmacological treatment pertaining to these three groups.

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Recommendations of the European Society of Cardiology on management of patients with non-STEMI acute coronary syndrome

Agnès Pasquet, Frédéric Maes Published in the journal : February 2021 Category : Cardiology

These new European Society of Cardiology guidelines concern the management of patients with acute coronary syndrome presenting without persistent ST-segment elevation. The central role of performing an electrocardiogram and troponin assessment in the initial diagnosis is highlighted. A rapid use of high-sensitive troponin schema for ruling out acute myocardial infarction enables us to safely discharge patients without any acute syndrome. Performing fast troponin assessments within 2 hours or 24 hours of admission allows to screen patients for coronary angiography and percutaneous revascularization. Following coronary artery stent placement, anti-platelet or anticoagulant regimens should be carefully chosen so as to balance the bleeding risk against the ischemic or thrombotic risk. The different protocols are reviewed herein according to the patients’ clinical situation. Lastly, the comprehensive treatment of patients is presented.

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Cardiological aspects of COVID-19 infection

Christophe Scavée, Agnès Pasquet, Christophe Beauloye Published in the journal : May 2020 Category : Cardiology

From the beginning of the COVID-19 crisis, physicians alerted the scientific community to the emergence of severe acute respiratory problems related to viral lung infections. The vast majority of these patients require oxygen therapy and 5 to 10% need assisted ventilation or even extracorporeal membrane oxygenation in the event of an uncontrolled situation. Poor prognosis factors mainly include age, as well as the presence of comorbidities such as hypertension, diabetes, obesity, but also cardiovascular diseases. Coronaviruses are known to attack the cardiovascular system, and it also appears that the virus might attack the heart muscle directly. Data relayed namely by Chinese and Italian physicians show that besides the lungs, certain patients develop sometimes severe cardiac problems, such as acute myocarditis, acute coronary syndrome (ACS), or arrhythmias that in turn lead to heart failure, shock, or cardiac arrest in those most affected. Cardiac damage is therefore a factor contributing to the poor prognosis of COVID-19 and it must be detected. Patients who have an ACS but whose pulmonary picture prevails may have their cardiac management dangerously delayed. Conversely, patients who present with an exclusively "cardiological" picture may not be properly diagnosed as COVID-19. Finally, the focus on COVID-19 and the patients' fear of the contagiousness of this virus may delay their presentation at the hospital. These data directly impact the way physicians and hospitals should consider COVID-19 cardiac patients, especially at the first signs of the disease. It is therefore essential to have recommendations for the management of all patients with preexisting heart problems and those with demonstrated myocardial damage caused by the virus.

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Recommendations of the European Society of Cardiology for diagnosis and management of chronic coronary disease

Agnès Pasquet Published in the journal : February 2020 Category : Cardiology

Coronary artery disease is one of the most prevalent diseases in cardiology, and patient care requires adapted treatment.

The new guidelines of the European Society of Cardiology regarding coronary artery disease present coronary artery disease as a continuum and propose a new protocol for its diagnosis or antithrombotic therapy

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European Society of Cardiology and European Society of Hypertension joint guidelines for the management of arterial hypertension: key messages

Agnès Pasquet, Alexandre Persu Published in the journal : February 2019 Category : Cardiology

The European Society of Cardiology and European Society of Hypertension have published new guidelines regarding management of hypertension. This paper summarizes the key messages of these guidelines.

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The role of the right ventricle in cardiac insufficiency

Marie-Bénédicte Benats, MD, Anne-Catherine Pouleur, MD, PhD, Agnès Pasquet, MD, PhD (1) Published in the journal : December 2017 Category : Cardiology

Right ventricular dysfunction is a strong predictor of mortality in patients with heart failure. Due to the configuration right ventricle, assessing the function of the right ventricle proves complex. Cardiac RMN is actually considered the gold standard to evaluate right volumes and right heart dysfunction. There is limited information available to date on the optimal management of right ventricular dysfunction, except in arterial pulmonary hypertension cases (Group 1). Future research is needed to determine specific treatments, improve prognosis, and increase quality of life of patients with right-sided heart failure.

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Amiodarone-induced thyrotoxicosis: benefits of total thyroidectomy

Florence Dive (1), Dominique Maiter (2), Michel Mourad (3), Jean-Benoit le Polain de Waroux (1), Sébastien Marchandise (1), Cynthia Barbraud (1), Hélène Dano (4), Christophe Scavée (1) Published in the journal : November 2017 Category : Cardiology

Amiodarone, a class III antiarrhythmic agent according to the Vaughan-Williams classification, is commonly prescribed to control supraventricular and ventricular arrhythmias, especially in patients with ventricular dysfunction. Amiodarone-induced hyperthyroidism may provoke serious cardiovascular complications, as illustrated by our two clinical cases. The diagnosis of amiodarone-induced thyrotoxicosis may prove tricky at times, and its medical treatment complex.

Surgical management of amiodarone-induced hyperthyroidism appears to be an attractive therapeutic option, particularly for patients with a risk of arrhythmias upon amiodarone discontinuation.

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What are the lessons learned from 2016 in cardiology?

Christophe Scavée, Agnès Pasquet Published in the journal : February 2017 Category : Cardiology

In 2016, two new drugs were introduced on the market in the field of rhythmology, namely Praxbind© and Brivaness©, with their indication revued and commented in this paper. In addition, the European Society of Cardiology published new guidelines. This article sought to review the guidelines' key points regarding dyslipidemia, atrial fibrillation, heart failure, and cardiovascular prevention.

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Case report of a scarcely-known entity: peripartum cardiomyopathy

Charlotte d’Odémont (1), Michel Henry (2), Pascale Grandjean (1) Published in the journal : January 2017 Category : Cardiology

Peripartum cardiomyopathy (PPCM) is defined as a non-familial form of peripartum heart failure and described as an “idiopathic cardiomyopathy presenting with heart failure secondary to left-ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery”. We have here reported the case of a young woman suffering from peripartum cardiomyopathy 2 months after delivery. This case provided us the opportunity to review etiology, diagnosis, and treatment of this little-known medical condition with occasionally serious outcome.

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From 1.0 medicine to 3.0 medicine : the connected patient

J. Melchior, F. Ndianabo Published in the journal : December 2016 Category : Cardiology

Mobile devices, tablets, and smart-phones have become essential tools in today's society, and they are also entering the healthcare field. We are slowly, but surely, approaching the e-medicine domain, inhabited by the e-patient, with all its advantages in terms of accessibility, yet also its complications, along with the need to rethink the current health care system.

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