Diagnosis and Treatment of Heart Failure - A New Horizon
¡@¡@Modern societies are characterised by raising living standards, lengthening life span and changes in diets (high calories, fat, and salt) and lifestyles such as smoking and lack of exercise. Diabetes, obesity, hypertension and coronary artery diseases are the consequences and these disease processes will lead to damage to the heart muscle and the clinical condition of heart failure. In every region of the world heart failure is common and increasing. In Hong Kong there has been on average 10% increase in hospital admissions for heart failure every year. In 2001, the hospital admission for heart failure in HA hospitals was 14,000, which represented a more than two-fold increase when compared with 6,000 in year 1997. ¡@¡@Heart failure, or the heart cannot pump out blood effectively to match the body's demands, will cause a substantial fall in quality of life with symptoms of breathlessness on mild exertion, swelling of the legs and body, and fatigue. Patients may lose ability to perform daily tasks and to work. The mortality of heart failure is high, worse than many cancers. The 3-year mortality for heart failure in general is 30-35%, while for severe patients, it is as high as 40-50%. At the Prince of Wales Hospital, the major teaching hospital of CUHK and one of the recognized centres in the world for leading medical research in CRT, 61 patients have received CRT and been followed up for 3.5 years. This treatment involves a new technology of implanting 3 pacing electrodes (instead of 1 or 2 in convention treatment) to different chambers of the heart to improve the heart function. The survival rate is 85% compared with 60% for patients with severe heart failure without this therapy. Patients also reported significant improvement of exercise capacity and echocardiography showed improvement of cardiac function. ¡@¡@While the current criteria for determining the suitability of CRT are very restrictive and not sensitive, the Division of Cardiology has employed cutting edge technology in echocardiography to diagnose and predict which patient group(s) will have the best response to CRT. Usually symptoms such as shortness of breath and fatigue can be easily neglected by patients and hence diagnosis will be delayed until very late or the situation is very severe and dangerous that hospitalization is required. In the assessment of heart failure patients, two newest technologies in echocardiography: tissue synchronization imaging and 3-dimensional echocardiography are introduced. Tissue synchronization imaging is a Doppler technology to compare the timing of contraction in different regions of heart muscles simultaneously and transform them into color codes. It is useful for immediate identification of uncoordinated contraction of the heart. The 3-dimensional echocardiography allows "real time" viewing of the heart structure and provides a better understanding between structure and function of the heart. These two new tools will also help doctors to select appropriate patients for CRT. ¡@¡@The Division of Cardiology of the Department of Medicine & Therapeutics, CUHK have organised in collaboration with Tsinghua University of Beijing the "International Heart Failure Symposium-Hong Kong 2004" on 21-22 February 2004 to highlight the importance of diagnosing heart failure early and providing optimal treatment and care for this very common and serious condition. The largest of the kind ever held in Hong Kong on the topic of heart failure, the symposium brings together physicians and allied health care professionals involved in heart failure from China, South-East Asia, Europe and the USA to share views and experiences. More than 20 renowned speakers in heart failure and related fields have been invited as international faculty for this landmark event. From
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