Insuficiência Cardíaca
description
Transcript of Insuficiência Cardíaca
![Page 1: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/1.jpg)
Insuficiência Cardíaca
Medicina II
R Palma Reis
![Page 2: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/2.jpg)
Insuficiência Cardíaca • O que é a insuficiência cardíaca• Dimensão do problema - Epidemiologia• Tipos de insuficiência cardíaca• Causas de I. Cardíaca• Avaliação do D. com I. Cardíaca
– Sintomas de I. Cardíaca– Exames complementares na I. Cardíaca
• Terapêutica da I. Cardíaca
![Page 3: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/3.jpg)
O que é a insuficiência cardíaca
• Situação em que a função cardíaca é insuficiente para as necessidades metabólicas.
• Apresenta:– Sintomas
– Alterações objectivas da função cardíacae, em geral
– Resposta à terapêutica dirigida à I.Cardíaca
![Page 4: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/4.jpg)
Insuficiência Cardíaca
Dados Epidemiológicos
![Page 5: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/5.jpg)
Prevalence of HF - USA
NHANES III. American Heart Association, 2003
![Page 6: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/6.jpg)
Prevalence of HF - Portugal
Ceia F et al. EPICA Study. Eur J Heart Failure 2002; 4:531-9
![Page 7: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/7.jpg)
Prevalence of HF – Portugal
Ceia F et al. EPICA Study. Eur J Heart Failure 2002; 4:531-9
Preserved systolic functionPreserved systolic functionSystolic dysfunctionSystolic dysfunction
![Page 8: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/8.jpg)
Future prevalence of HF - USA
Braunwald, 2006, pag 604
![Page 9: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/9.jpg)
Hospital discharges for HF - USA
American Heart Association, 2002
![Page 10: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/10.jpg)
Tipos de insuficiência cardíaca
• Crónica vs Aguda
• Sistólica vs Diastólica
• Direita vs Esquerda
• Baixo débito vs Alto débito
![Page 11: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/11.jpg)
Causas de I. CardíacaCausas de base
• Doença miocárdica
– Cardiopatia isquémica
– D. Hipertensiva
– Miocardiopatia idiopática / viral
• Doença valvular
• D. pericárdica
![Page 12: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/12.jpg)
Importance of IHD in HF pts CHARM – POPULATION
History - % Alternative
(n=2028)Added(n=2548)
Preserved
(n=3023)Overall(n=7599)
Miocardial infarction
61 56 44 53
Diabetes 27 30 28 28Hypertension 50 48 64 55Atrial Fibrillation
25 26 29 27
![Page 13: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/13.jpg)
HF in patients with AMI• TRACE study (Trandalopril/placebo, 6526 pts)
Cleland JGF, et al. Heart 2005; 91:7-13
![Page 14: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/14.jpg)
HF in patients with AMITemporal trends
Weir RAP, et al. Am J Cardiol 2006; 97:13F-25F
![Page 15: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/15.jpg)
Causes of HF - 1993
Prevalence of causes for the development of congestive heart failure by gender in the Framingham Heart Study cohort. J Am Coll Cardiol 1993
![Page 16: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/16.jpg)
Causes of HF - 2001
NHANES I. Arch Int Med, 2001
![Page 17: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/17.jpg)
Espiga Macedo et al, J Hypertension 2005
Prevalence of Hypertension in PortugalPrevalence of Hypertension in PortugalPrevalence of Hypertension in PortugalPrevalence of Hypertension in PortugalPrevalence of Hypertension (BP > 140 / 90 mm Hg)
Total
42.1 %
![Page 18: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/18.jpg)
Hypertension in PortugalAwareness, Treatment and Control
Age Aware Treated Controld Controld treated
Total 45.7 (11.1) 39.9 (1.0) 11.2 (0.7) 28.6 (1.5)
< 35 y 12.1 (0.7) 5.2 (0.5) 2.0 (0.8) 37.5 (1.7)
35-64 y 44.6 (1.1) 36.5 (1.0) 13.0 (1.0) 35.6 (1.6)
> 64 y 63.3 (1.0) 58.0 (1.1) 12.1 (1.2) 20.8 (1.4)
% - Total
Espiga Macedo et al, J Hypertension 2005
![Page 19: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/19.jpg)
Epica study – Predisponents of HF in Portugal
• Hypertension – 80 %
• Coronary Artery Disease – 39 %
• Atrial Fibrillation – 15 %
F Ceia, Epica Study, Eur J Heart Failure, 2004
![Page 20: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/20.jpg)
Causas de I. CardíacaPrecipitação ou agravamento
• Suspensão da terapêutica• Infecções (respiratórias, urinárias, etc)• Anemia• Disritmias (entrada em FA)• Embolismo pulmonar• Nova D. Cardíaca ( EAM, miocardite)• Esforços• Fármacos cardiodepressores (alcool, citostáticos)
![Page 21: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/21.jpg)
Avaliação do D. com I. Cardíaca Sintomas de I. Cardíaca
• I C Esquerda– Dispneia, Ortopneia, DP nocturna– Cansaço– Alt urinárias (nicturia, oligúria)
• I C Dta– Edemas, Hepatomegalia, Enteropatia exsudativa,
Cansaço
• As classes de NYHA
![Page 22: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/22.jpg)
Exames complementares na I. Cardíaca
• ECG - em geral alterado - HVE, sobrecarga, BCRE, Qs, FA...
• Rx Torax - em geral alterado - cavidades cardíacas, cefalização / congestão pulmonar
• Ecocardiografia - Dim / Função /Válvulas / Disf Diast
• Labº - Anemia, PoliglobuliaUreia e creatinina, etc
![Page 23: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/23.jpg)
Outros exames na I. Cardíaca
• Testes de função pulmonar (DD D. Pulmonar)
• Cardiologia nuclear
• Prova de esforço
• Registo de Holter de 24 h
• Cateterismo - D. Coronária ?
• Avaliação neuro-endócrina
![Page 24: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/24.jpg)
Terapêutica da I. Cardíaca• Medidas gerais
– Dieta (sal, cal e alcool), exercício mod, parar tabaco
• Medicamentos– Diuréticos - congestão (doses << )– IECAS - função e prognóstico (doses >>)– Digitálicos (FA e dilatação VE)– Anticoagulantes (FA, valvulopatias)
• Cirurgia - CABG - Pace M -Transplante cardíaco
![Page 25: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/25.jpg)
HF = High mortality
Braunwald, 2006, pag 552
How to decrease incidence / mortality?
![Page 26: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/26.jpg)
Treatment of HF after an AMIto improve prognosis
• ACE inhibitors
• ARBs
• Beta Blockers
• Aldosterone Blockers
![Page 27: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/27.jpg)
ACEi and Ischemic HF
Weir R,McMurray JJV. Heart 2005; 91:17-20
![Page 28: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/28.jpg)
ARBs and prognosis of HF
Charm
![Page 29: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/29.jpg)
B Blockers in HF
![Page 30: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/30.jpg)
B Blockers in HF
![Page 31: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/31.jpg)
ACE i + B Blocker in HF
Weir R,McMurray JJV. Heart 2005; 91:17-20
![Page 32: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/32.jpg)
ACE i + B Blocker + Aldosterone antagonist in HF
Weir R,McMurray JJV.,Heart 2005; 91:17-20
![Page 33: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/33.jpg)
Algorithm for the treatment of AMI with HF or LVSD
Weir R,McMurray JJV. Heart 2005; 91:17-20
![Page 34: Insuficiência Cardíaca](https://reader035.fdocumentos.com/reader035/viewer/2022062301/56814842550346895db55a87/html5/thumbnails/34.jpg)
Temas Abordados - Insuficiência Cardíaca • O que é a insuficiência cardíaca• Dimensão do problema - Epidemiologia• Tipos de insuficiência cardíaca• Causas de I. Cardíaca• Avaliação do D. com I. Cardíaca
– Sintomas de I. Cardíaca– Exames complementares na I. Cardíaca
• Terapêutica da I. Cardíaca