Differences in presentations and responses to management of new onset heart failure versus long standing heart failure - Nguyễn Văn Việt Thắng

Differences in Presentations and 
Responses to Management 
of New Onset Heart Failure 
versus Long Standing Heart Failure 
Presenter: Nguyễn Văn Việt Thắng 
Current definition of Heart Failure is vague and impractical 
 New classification of Heart Failure based on a 
new test – the SEFV test. 
 Treatment according to the result of the test. 
BACKGROUND 
BACKGROUND 
The SEFV test 
Method 
The result 
Fluid distribution 
Three 
compartments 
of the body 
Intravascular 
compartments 
Intra-arterial 
compartment 
Intra-venous 
compartment 
Extravascular 
compartment 
New Non-Invasive SEFV test 
Size and Expansion of the Femoral Vein test 
• The SEFV is the ultrasound study examining the size of the 
femoral vein and its expansion with cough. 
• The ultrasound plane of the femoral artery and vein to be 
checked is the coronal plane immediately proximal to the 
bifurcation of the superficial and deep femoral artery. 
SEFV 
Size and Expansibility of the Femoral Vein test 
SEFV 
Here at the distal end of 
the common femoral 
artery, the coronal plane 
of the artery is seen as a 
single round structure 
which pulsates. Next to 
it is the femoral vein. 
Principles of SEFV 
The first principle: The volume of blood going 
through the femoral artery and returning 
through the common femoral vein should be the 
same. 
Principles of SEFV 
The second principle: In the vascular system, 
most of the circulating blood is in the veins. The 
amount of blood in the arteries is small and the 
size of the arteries does not change much due to 
vascular tone in order to keep a fairly constant 
blood pressure. 
Normal expansion of femoral vein 
(no fluid overload + no dehydration) 
METHOD 
Patients were enrolled and physical examination was recorded: 
• Fluid overload in the venous system: presence of rales in the lung 
and painful sensation with a minimal punch in the right lower rib 
cage (fluid in the liver). 
METHOD 
• Fluid overload in the extravascular system: fluid 
infiltration in the abdominal wall, edema at the ankle, 
thigh, dependent areas (e.g. presacral area, etc). 
METHOD 
Low perfusion in the arterial compartment consists of 
• Low blood pressure. 
• Cerebral hypo-perfusion (causing dizziness or change of 
mental status). 
• Renal perfusion (causing pre-renal azotemia (increased blood 
urea nitrogen). 
• Distal peripheral arterial system perfusion (causing fatigue or 
exercise intolerance) 
Location of fluid overload 
*Patients with more intravenous fluid overload 
ACEI + BB + Short term fast acting loop diuretics 
 (eg: furosamide). 
*Patients with more extravascular fluid overload 
ACEI + BB + Long acting, lower dose diuretics 
 (eg: HCTZ). 
RESULTS 
50 patients were enrolled from January 2015 to April 
2016. All came with shortness of breath and had a 
diagnosis of HF in the emergency room. All the 
patients were diagnosed with HF with low or 
preserved EF 
60% patients with long standing dilated 
cardiomyopathy had more extravascular fluid 
overload 
Compared to only 30% patients of recent dilated 
cardiomyopathy 
RESULTS 
 The patients with new or recent onset of dilated 
cardiomyopathy recovered faster (within 24 hours) 
while the other patients took longer to recover. 
 These latter patients also needed more 
medications 
CONCLUSION 
Based on the location of the fluid overload, 
the patients with new onset of HF were faster 
to recover with less times and lower need for 
resources 
REFERENCE 
• Thach Nguyen, Advait Soni, Chau BL Vien, Ryan Phan, 
Tung Mai. “Differences of Presentations and 
Responses to Management of New Onset Heart 
Failure versus Long Standing Heart Failure.”