Kỹ thuật mới đánh giá suy tim lần đầu tiên trên người

stiff LV due to age easy to get sick Vulnerable, mildly sick person + + High D.. Symptomatic compromised LV diastolic function stiff LV due to age Really sick, Recover fast and st

New Definition and Best Assessment of Heart Failure:

Symptoms and Signs of Heart Failure Are

Non Specific

The same symptoms and signs can be found in Heart failure,

COPD, Chronic kidney failure Cirrhosis of the liver Pulmonary hypertension

Pericarditis

1 When I am consulted to see a patient with possible heart failure, after I examine

the patient, what is my answer?

I don’t know whether the patient has HF however what I am sure is whether the

patient has fluid overload

2 Does the patient have extravascular fluid

overload? Does the patient have intravascular fluid overload?

Extravascular Fluid Overload

Intravascular Fluid Overload

The new classification:

The Vietnam Classification of Heart Failure

IntraV ExtraV E F Patient Profile

- - High A Normal heart, no fluid overload

- + High B Normal heart with fluid overload (Healthy sick)

+ - High C Compromised LV function (e.g stiff LV due to age) (easy

to get sick)

(Vulnerable, mildly sick person)

+ + High D Symptomatic compromised LV diastolic function (stiff LV

due to age )

(Really sick, Recover fast and stay healthy for long time)

Profile A: No Extravascular No

Intravascular Fluid Overload normal

heart (Not Sick)

Profile B: Extravasc (+) Intravasc (-)

Fluid Overload, normal EF (Healthy Sick)

Profile C: Extravasc (-) Intravasc (+) Fluid Overload, Norm EF Not sick now, easy to

become sick (vulnerable person)

Profile D: Intravasc (+) Extravac (+)

Fluid Overload, Normal EF: Sick Patient (however patient will recover and stay

healthy if treated well)

Profile A1: I (-) E (-) Low EF Well Compensated Patient with LVAD

Profile B1: I (-) E (+) Low EF

Mildly symptomatic, Improved with

treatment and prevention

Profile C1: I (+) E (-) Low EF Very Vulnerable: Pseudo-stable

Profile D1: I (+) E (+) Low EF

Really Sick

- - High A Normal heart, no fluid overload

- + High B Normal heart with fluid overload

(Healthy sick)

+ - High C Compromised LV function (e.g

stiff LV due to age) (easy to get sick)

(Vulnerable, mildly sick person)

+ + High D Symptomatic compromised LV

diastolic function (stiff LV due to age )

(Really sick, Recover fast and stay healthy for long time)

This classification is better than the

ACC/AHA, NYHA classification

Why is this classification relevant?

1 Because it can give an exact assessment

of the present condition

A Intravascular fluid

B Extravascular fluid

C Ejection fraction

2 Because it can show where to remove the

fluid

A Intravascular fluid

B Extravascular fluid

3 Because it can predict short term and

long term future

Extra> Intra > low EF

ROAD MAP

Toward recovery Disease Progress

ROAD MAP 1

Toward recovery

Disease Progress

Problems in Premature Discharge

and Early Readmissions

B1 (I- E+) C1 (I+ E-) D1 (I+E+

Patient with intravascular contraction and extravascular fluid

overload

B1 (I- E+)

Can Physical Examination detect accurately intervascular fluid overload?

Vascular Probe with Regular Echo

Equipment

Location to measure the size of the

femoral artery and vein

Femoral Vein Femoral Artery

Patient with Fluid overload

Much larger femoral vein Femoral Artery

Patient with Bleeding

Smaller Femoral Vein Femoral Artery

Patient with syncope due to orthostatic hypotension (excessive venous dilation)

Huge Femoral Vein with cough Femoral Vein

at baseline

Patient with Enlarged Femoral Vein and Normal EF= Diastolic HF The heart is not sick The capacitance of the venous system is

overwhelmed

This new technique is useful in…

1 Diagnosis of heart failure,

2 Extent of internal acute blood loss,

3 Diagnosis of syncope

4 Diagnosis of orthostatic hypotension,

5 Confirm HF in patient with COPD,

6 Confirm HF with chronic kidney dis

7 Confirm HF in patient with cirrhosis

8 Confimr fluid overload in patient with normal EF (misnomer diastolic HF)

Extravascular Fluid Overload

Intravascular Fluid Overload

- - High A Normal heart, no fluid overload

- + High B Normal heart with fluid overload

(Healthy sick)

+ - High C Compromised LV function (e.g

stiff LV due to age) (easy to get sick)

(Vulnerable, mildly sick person)

+ + High D Symptomatic compromised LV

diastolic function (stiff LV due to age )

(Really sick, Recover fast and stay healthy for long time)

This classification is better than the

ACC/AHA, NYHA classification

Patient with Fluid overload

Much larger femoral vein Femoral Artery

ROAD MAP

Toward recovery Disease Progress

ROAD MAP 1

Toward recovery

Disease Progress

Problems in Premature Discharges

and Early Readmissions

B1 (I- E+) C1 (I+ E-) D1 (I+E+

1 Diagnosis of heart failure,

2 Extent of internal acute blood loss,

3 Diagnosis of syncope

4 Diagnosis of orthostatic hypotension,

5 Confirm HF in patient with COPD,

6 Confirm HF with chronic kidney dis

7 Confirm HF in patient with cirrhosis

8 Confimr fluid overload in patient with normal EF (misnomer diastolic HF)

- - High A Normal heart, no fluid overload

- + High B Normal heart with fluid overload

(Healthy sick)

+ - High C Compromised LV function (e.g

stiff LV due to age) (easy to get sick)

(Vulnerable, mildly sick person)

+ + High D Symptomatic compromised LV

diastolic function (stiff LV due to age )

(Really sick, Recover fast and stay healthy for long time)

This classification is better than the

ACC/AHA, NYHA classification

Patient with Fluid overload

Much larger femoral vein Femoral Artery

Thank You Contact for new clinical trial: thachnguyen 2000@yahoo.com