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Differences in Presentations and Responses to Management of New Onset Heart Failure versus Long Standing Heart Failure Presenter: Nguyễn Văn Việt Thắng... New Non-Invasive SEFV test S

Differences in Presentations and

Responses to Management

of New Onset Heart Failure

versus Long Standing Heart Failure

Presenter: Nguyễn Văn Việt Thắng

Current definition of Heart Failure is vague and impractical

 New classification of Heart Failure based on a

new test – the SEFV test

 Treatment according to the result of the test

BACKGROUND

The SEFV test

Method

The result

Fluid distribution

Three compartments

of the body

Intravascular compartments

Intra-arterial

compartment

Intra-venous compartment

Extravascular compartment

New Non-Invasive SEFV test

Size and Expansion of the Femoral Vein test

• The SEFV is the ultrasound study examining the size of the femoral vein and its expansion with cough

• The ultrasound plane of the femoral artery and vein to be checked is the coronal plane immediately proximal to the bifurcation of the superficial and deep femoral artery

SEFV

Size and Expansibility of the Femoral Vein test

SEFV

Here at the distal end of the common femoral artery, the coronal plane

of the artery is seen as a single round structure which pulsates Next to

it is the femoral vein

Principles of SEFV

The first principle: The volume of blood going

through the femoral artery and returning

through the common femoral vein should be the same

Principles of SEFV

The second principle: In the vascular system,

most of the circulating blood is in the veins The amount of blood in the arteries is small and the size of the arteries does not change much due to vascular tone in order to keep a fairly constant blood pressure

Normal expansion of femoral vein

(no fluid overload + no dehydration)

METHOD

Patients were enrolled and physical examination was recorded:

• Fluid overload in the venous system: presence of rales in the lung and painful sensation with a minimal punch in the right lower rib cage (fluid in the liver)

METHOD

• Fluid overload in the extravascular system: fluid

infiltration in the abdominal wall, edema at the ankle, thigh, dependent areas (e.g presacral area, etc)

METHOD

Low perfusion in the arterial compartment consists of

• Low blood pressure

• Cerebral hypo-perfusion (causing dizziness or change of

mental status)

• Renal perfusion (causing pre-renal azotemia (increased blood urea nitrogen)

• Distal peripheral arterial system perfusion (causing fatigue or

exercise intolerance)

Location of fluid overload

*Patients with more intravenous fluid overload

ACEI + BB + Short term fast acting loop diuretics

(eg: furosamide)

*Patients with more extravascular fluid overload

ACEI + BB + Long acting, lower dose diuretics

(eg: HCTZ)

RESULTS

50 patients were enrolled from January 2015 to April

2016 All came with shortness of breath and had a diagnosis of HF in the emergency room All the

patients were diagnosed with HF with low or

preserved EF

60% patients with long standing dilated

cardiomyopathy had more extravascular fluid

overload

Compared to only 30% patients of recent dilated

cardiomyopathy

RESULTS

 The patients with new or recent onset of dilated

cardiomyopathy recovered faster (within 24 hours) while the other patients took longer to recover

 These latter patients also needed more

medications

CONCLUSION

Based on the location of the fluid overload, the patients with new onset of HF were faster

to recover with less times and lower need for

resources

REFERENCE

• Thach Nguyen, Advait Soni, Chau BL Vien, Ryan Phan,

Tung Mai “Differences of Presentations and

Responses to Management of New Onset Heart

Failure versus Long Standing Heart Failure.”