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A Pilot of a Heart Failure Stabilisation Clinic
Abstracts
ward later that day. Due to Caesarean section 12 days earlier, thrombolysis was contraindicated. Mechanical thrombectomy deemed unsuitable following cerebral angiogram due to small vessels involved.MRI-Brain showed small infarcts in left parietal cortex. Haemiplegia largely resolved with anticoagulation. Subsequent TTEs and trans-oesophageal echocardiogram showed thrombus in right ventricle as well as LV despite anticoagulation. Five days later patient developed painful, cold toes on right foot, with absent pulses. Lower limb CT angiogram showed emboli in right lower limb arteries. INR target range increased to 3-3.5. Eventual resolution of intra and extra cardiac thrombus, with small area of residual haemorrhagic transformation in parietal lobe. Patient underwent tubal ligation once more stable. http://dx.doi.org/10.1016/j.hlc.2016.06.223 223 A Pilot of a Heart Failure Stabilisation Clinic M. Bartlett ∗ , H. Klimis, E. Khan, M. Patel, A. Thiagalingam, M. Altman, D. Wynne, R. Denniss, C. Chow Westmead Hospital, Sydney, Australia Background: Our pilot Heart failure Stabilisation clinic has been established within the Western Sydney Integrated Care program. It aims to facilitate early discharge, transition to the community, optimisation of treatments and decrease unplanned admissions. It commenced in July 2015 and is a weekday daily service that operates in conjunction with Rapid Access Cardiology clinics to share staffing of a Cardiologist, Registrar and Clinical Nurse Consultant. We described initial referrals and key performance indicators. Results: There were a total of 36 patients referred, 72% (26) from inpatient Cardiologists, 3% (1) from Emergency department and 15% (7) from other referrers. The average length of stay of inpatient referrals was 6.8 days, compared with 8.0 days for other Cardiology heart failure admissions in 2015. Only one patient did not attend their appointment. Of the 36 patients, 25 had their first visit within 10 days. The number of contact visits ranged from 1 to 6. 69% (25) of patient’s had medications up titrated during their visits. The average age was 67 years, the majority (n=34) had systolic dysfunction (LVEF 22 – 54%) with ischaemic cardiomyopathy as the main diagnosis. 100% reported they ‘agreed’ or ‘strongly agree’ that there was adequate verbal communication about test results and management plan and 100% reported they ‘agreed’ or ‘strongly agreed’ that the new health service was useful to the community. Conclusion: The Stabilisation clinic may facilitate early discharge from hospital and may help optimise medication management. Patients were happy with the service and perceived the service to have utility. http://dx.doi.org/10.1016/j.hlc.2016.06.224
S95
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
224 Amyloid Cardiomyopathy Mimicking Reverse Takotsubo Cardiomyopathy O. Gibbs 1,∗ , J. Otton 1 , A. Makris 2 , J. French 1 1 Department
of Cardiology, Liverpool Hospital, Sydney, Australia 2 Department of Nephrology, Liverpool Hospital, Sydney, Australia A 74 year old gentleman was referred for coronary angiography with heart failure symptoms and elevated troponin in the context of hypertension, dyslipidaemia and a remote smoking history. Angiogram revealed minor disease. Left ventriculogram showed antero-basal and infero-basal hypokinesis and in the context of a recent stressful event the patient was treated for reverse Takotsubo cardiomyopathy with planned outpatient follow-up. Full blood count, electrolytes and creatinine were within normal limits at the time.
He presented a month later with progressive symptoms and gross fluid overload. He was found to have acute kidney injury, nephrotic range proteinuria and biventricular heart failure. Subsequent renal biopsy revealed AL amyloid. Bone marrow biopsy confirmed plasma cell myeloma. Echocardiogram revealed classic features of cardiac amyloid such as granular myocardium, biventricular wall and valve thickening and a typical left ventricular strain pattern with relative sparing of the apex. Interestingly there was also relative sparing of apical systolic wall motion in the apical views. ECG showed low voltage QRS complexes. The patient was subsequently deemed unsuitable for bone marrow transplant, was treated for heart failure and is undergoing chemotherapy and dialysis in the outpatient setting. To our knowledge, this is the first case report relating these two conditions. Amyloid cardiomyopathy should be considered in the differential diagnosis of reverse Takostubo cardiomyopathy. http://dx.doi.org/10.1016/j.hlc.2016.06.225
ward later that day. Due to Caesarean section 12 days earlier, thrombolysis was contraindicated. Mechanical thrombectomy deemed unsuitable following cerebral angiogram due to small vessels involved.MRI-Brain showed small infarcts in left parietal cortex. Haemiplegia largely resolved with anticoagulation. Subsequent TTEs and trans-oesophageal echocardiogram showed thrombus in right ventricle as well as LV despite anticoagulation. Five days later patient developed painful, cold toes on right foot, with absent pulses. Lower limb CT angiogram showed emboli in right lower limb arteries. INR target range increased to 3-3.5. Eventual resolution of intra and extra cardiac thrombus, with small area of residual haemorrhagic transformation in parietal lobe. Patient underwent tubal ligation once more stable. http://dx.doi.org/10.1016/j.hlc.2016.06.223 223 A Pilot of a Heart Failure Stabilisation Clinic M. Bartlett ∗ , H. Klimis, E. Khan, M. Patel, A. Thiagalingam, M. Altman, D. Wynne, R. Denniss, C. Chow Westmead Hospital, Sydney, Australia Background: Our pilot Heart failure Stabilisation clinic has been established within the Western Sydney Integrated Care program. It aims to facilitate early discharge, transition to the community, optimisation of treatments and decrease unplanned admissions. It commenced in July 2015 and is a weekday daily service that operates in conjunction with Rapid Access Cardiology clinics to share staffing of a Cardiologist, Registrar and Clinical Nurse Consultant. We described initial referrals and key performance indicators. Results: There were a total of 36 patients referred, 72% (26) from inpatient Cardiologists, 3% (1) from Emergency department and 15% (7) from other referrers. The average length of stay of inpatient referrals was 6.8 days, compared with 8.0 days for other Cardiology heart failure admissions in 2015. Only one patient did not attend their appointment. Of the 36 patients, 25 had their first visit within 10 days. The number of contact visits ranged from 1 to 6. 69% (25) of patient’s had medications up titrated during their visits. The average age was 67 years, the majority (n=34) had systolic dysfunction (LVEF 22 – 54%) with ischaemic cardiomyopathy as the main diagnosis. 100% reported they ‘agreed’ or ‘strongly agree’ that there was adequate verbal communication about test results and management plan and 100% reported they ‘agreed’ or ‘strongly agreed’ that the new health service was useful to the community. Conclusion: The Stabilisation clinic may facilitate early discharge from hospital and may help optimise medication management. Patients were happy with the service and perceived the service to have utility. http://dx.doi.org/10.1016/j.hlc.2016.06.224
S95
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
224 Amyloid Cardiomyopathy Mimicking Reverse Takotsubo Cardiomyopathy O. Gibbs 1,∗ , J. Otton 1 , A. Makris 2 , J. French 1 1 Department
of Cardiology, Liverpool Hospital, Sydney, Australia 2 Department of Nephrology, Liverpool Hospital, Sydney, Australia A 74 year old gentleman was referred for coronary angiography with heart failure symptoms and elevated troponin in the context of hypertension, dyslipidaemia and a remote smoking history. Angiogram revealed minor disease. Left ventriculogram showed antero-basal and infero-basal hypokinesis and in the context of a recent stressful event the patient was treated for reverse Takotsubo cardiomyopathy with planned outpatient follow-up. Full blood count, electrolytes and creatinine were within normal limits at the time.
He presented a month later with progressive symptoms and gross fluid overload. He was found to have acute kidney injury, nephrotic range proteinuria and biventricular heart failure. Subsequent renal biopsy revealed AL amyloid. Bone marrow biopsy confirmed plasma cell myeloma. Echocardiogram revealed classic features of cardiac amyloid such as granular myocardium, biventricular wall and valve thickening and a typical left ventricular strain pattern with relative sparing of the apex. Interestingly there was also relative sparing of apical systolic wall motion in the apical views. ECG showed low voltage QRS complexes. The patient was subsequently deemed unsuitable for bone marrow transplant, was treated for heart failure and is undergoing chemotherapy and dialysis in the outpatient setting. To our knowledge, this is the first case report relating these two conditions. Amyloid cardiomyopathy should be considered in the differential diagnosis of reverse Takostubo cardiomyopathy. http://dx.doi.org/10.1016/j.hlc.2016.06.225