Maryland ACEP Chapter Educational Conference & Annual Meeting - - PDF document

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Maryland ACEP Chapter Educational Conference & Annual Meeting - - PDF document

Maryland ACEP Chapter Educational Conference & Annual Meeting March 12, 2020 FACULTY: Tiffany C. Fong, MD, FACEP PRESENTATION HFrEF, HFpEF, what the (EF)? Point-of-Care Echo in the Evaluation of Heart Failure DESCRIPTION Decompensated heart


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Maryland ACEP Chapter Educational Conference & Annual Meeting March 12, 2020

FACULTY: Tiffany C. Fong, MD, FACEP PRESENTATION HFrEF, HFpEF, what the (EF)? Point-of-Care Echo in the Evaluation of Heart Failure DESCRIPTION Decompensated heart failure is a commonly encountered clinical syndrome in the emergency

  • department. Though emergency care providers have significant comfort with the diagnosis and

management of patients with reduced ejection fraction, heart failure with preserved ejection fraction can be more enigmatic. This talk will provide an overview of the relevant pathophysiology, point-of-care echo findings, and management of HFrEF and HFpEF. OBJECTIVES

  • Recognize the clinical syndromes of heart failure with reduced and preserved ejection fraction

(HFrEF and HFpEF).

  • Describe multiple techniques to estimate ejection fraction on point-of-care echocardiography.
  • Explain the basic physiology of left ventricular diastole.
  • Identify key sonographic findings in HFpEF.
  • Describe the management strategies for HFrEF and HFpEF.

DISCLOSURE No significant financial relationships to disclose.

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Tiffany Fong, MD FACEP 3/12/2020

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HEART FAILURE

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HFrEF and HFpEF

Have NO significant differences in their physical exam findings

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JAMA 2005

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First discrimination point in CHF:

Determine preserved vs. reduced ejection fraction

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EYEBALLING EF

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EPSS TO ESTIMATE EF

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FRACTIONAL SHORTENING

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MAPSE

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HFpEF

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HFpEF

WHY DOES DIASTOLIC DYSFUNCTION MATTER?

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HFpEF

Lower mortality rate than HFrEF (3 vs 4%) but similar or higher morbidity (ICU, hospital LOS)

DIASTOLE

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DIY:

DIASTOLIC EVALUATION

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KEY: Identify ↑LA pressure

Greenstein & Mayo – Chest 2018;153(3)

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PW DOPPLER OF MITRAL INFLOW VELOCITY

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Greenstein & Mayo – Chest 2018;153(3)

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TISSUE DOPPLER OF LATERAL MV ANNULUS

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NEJM 2004;351

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Figure: Liang 2010

SUPPORTING EVIDENCE

OF DIASTOLIC EVALUATION

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*EVOLVING THOUGHT:

HFpEF IS NOT SIMPLY DIASTOLIC DYSFUNCTION

BASIC TREATMENT

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NEJM 2004

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CORRECT DX DECONGEST

CONTROL HTN CONTROL AFIB

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PUTTING IT TOGETHER (Clinical Case)

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SUMMARY

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THANK YOU!

tfong3@jhmi.edu