http://www.medrants.com/archives/4991 Contemplating medicine and the health care system Tue, 16 Mar 2010 14:53:42 +0000 http://wordpress.org/?v=2.9.2 hourly 1 http://www.medrants.com/archives/4991/comment-page-1#comment-529731 Moises Auron Thu, 19 Nov 2009 19:10:14 +0000 http://www.medrants.com/?p=4991#comment-529731 I agree - it is a very common error when patients with exacerbation of chronic heart failure are admitted - instead of targeting euvolemia, it seems that the limiting point in using diuretics is when creatinine starts bumping up - this is a mistake, as patients with chronic heart failure (either with preserved or low ejection fraction) can develop cardiorenal syndrome even in the setting of volume overload (as are intravascularly volume depleted in addition to poor pump functioning). I feel a challenge with the heart failure with preserved ejection fraction - as even with a normal EF, they can in fact have a systolic dysfunction - the issue is that we need to use more technology in this patients - use tissue doppler along with the echocardiogram. You can access the presentation here: <a href="http://www.scribd.com/doc/20416429/EBM-Diastolic-HF" rel="nofollow">http://www.scribd.com/doc/20416429/EBM-Diastolic-HF</a> I made a presentation for my colleagues hospitalists about this setting - it is so difficult as well to get out the name of "diastolic heart failure" and I hope Medicare will take this mistaken name out of its diagnosis list. Excellent posts, I enjoy very much reading your updates. Best! Moises I agree – it is a very common error when patients with exacerbation of chronic heart failure are admitted – instead of targeting euvolemia, it seems that the limiting point in using diuretics is when creatinine starts bumping up – this is a mistake, as patients with chronic heart failure (either with preserved or low ejection fraction) can develop cardiorenal syndrome even in the setting of volume overload (as are intravascularly volume depleted in addition to poor pump functioning).
I feel a challenge with the heart failure with preserved ejection fraction – as even with a normal EF, they can in fact have a systolic dysfunction – the issue is that we need to use more technology in this patients – use tissue doppler along with the echocardiogram. You can access the presentation here: http://www.scribd.com/doc/20416429/EBM-Diastolic-HF
I made a presentation for my colleagues hospitalists about this setting – it is so difficult as well to get out the name of "diastolic heart failure" and I hope Medicare will take this mistaken name out of its diagnosis list.
Excellent posts, I enjoy very much reading your updates.
Best!
Moises

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