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Chronic heart failure (ICC) affects mainly elder people, and affects widely their health and life quality. Diagnosis is based on clinical terms – left and right ICC pictures being different. Treatment involves ACE inhibitor, betablockers, diuretics, aldosterone receptor antagonists and ivabradin/digoxin. Treatment efficiency is well established for systolic ICC; it must be more adequatly documented in diastolic ICC. Educational therapy and long-term following must be put in place. Several new agents are being studied (e.g., LLCZ696 et empagliflozine) [ABSTRACT FROM AUTHOR]

Summary: Objective: Offering possible directions and options for practical exercise programs in rehabilitation centres, after a review of a set of 46 trials about physical rehabilitation of patients with heart failure. News: There are a lot of trials about physical training. However, it is not easy to propose a physical training program because trials sometimes use very different protocols as to modality, intensity, period and frequency of exercise. Perspectives and projects: Offering complete physical rehabilitation programs (aerobie training and strength training), adapted to patients with heart failure and coherent in intensity prescriptions, length of sessions and programs as well as in intensity of practice, taking into account the institutional constraints. Conclusion: It is important to have an overview of the various existing trials in addition to official recommendations on physical rehabilitation so that professionals can guide physical programs to make them best adapted to each patient. [Copyright &y& Elsevier]

Abstract: Heart failure is a chronic, common and severe disease. It leads to frequent hospitalizations and decrease of patient''s quality of life. A therapeutic patient education program, named “school of heart failure” was implemented at Antoine-Béclère hospital. Aim of the study: To assess the effectiveness of this program. Patients and methods: This therapeutic patient education program included patients with heart failure, hospitalized in a cardiology unit. Four types of evaluation were carried out: evaluation of patients’ skills before they leave the hospital, patient''s knowledge (associated with the degree of certainty), satisfaction regarding the program and self-assessment of changes in their lifestyle 3 months after discharge. Results: Twenty-four patients were included in 9 months. The program''s evaluation showed promising results with respect to the acquisition of skills (94%), the improvement of patients’ knowledge associated with self-confidence increase, their satisfaction towards the program (80%) and their ability to change their habits (75%). Self-assessment has demonstrated changes in their lifestyle. Conclusion: These preliminary results are promising according to the program''s effectiveness and its ability to meet patients’ educational needs. The program was certified by French authorities in 2011. Knowledge and skills acquisition will have to be confirmed on long term. [Copyright &y& Elsevier]

Abstract: In patients with chronic heart failure, the efficacy of beta-blocker therapy on mortality and the multiple benefits observed with physical training justify the association of the both. The effects of betablockade on different systems solicited in the exercise, particularly on the cardiocirculatory response during exercise test, rise many questions about the impact of beta blocker treatment on the changes induced by physical training. The cardioselective and vasodilating properties of beta-blockers play a role. It seems that the improved performance assessed by peak oxygen uptake (peak VO2) resulting from physical training is not limited by the beta-blocker treatment in patients with chronic heart failure. Synergistic effects have been observed, but many issues remain unsolved. [Copyright &y& Elsevier]

Summary: A fast heart rate or an irregular ventricular rhythm can produce various degrees of functional impairment and structural remodeling of the ventricle referred to as tachycardia-related cardiomyopathy or tachycardiomyopathy. This form of myocardial dysfunction can be caused by supraventricular or ventricular tachyarrhythmias that are incessant and associated with ventricular rates higher than 120 bpm. It can be reversed with pharmacological or nonpharmacological rate control or arrhythmia reversion. The prevalence of ventricular and supraventricular tachyarrhythmias is high among patients with heart failure. Consequently, in clinical settings, it may be difficult to determine whether a patient with severe ventricular dysfunction and supraventricular tachyarrhythmia associated with a rapid ventricular response is suffering from tachycardiomyopathy or from heart failure complicated by the subsequent development of a supraventricular tachyarrhythmia (e.g. atrial fibrillation). This typical “chicken-or-the-egg” dilemma can be resolved by treating the arrhythmia (pharmacological or nonpharmacological rate and/or rhythm control) and closely monitoring the evolution of the left ventricular dysfunction. Proper management of tachycardiomyopathy requires appropriate decision making, use of both pharmacological and nonpharmacological treatment approaches, and close follow-up. The purpose of this review article is to examine currently available data (experimental and clinical) on this complex clinical entity and on rate-control therapy. [Copyright &y& Elsevier]

Abstract: Symptom-limited exercise test with peak oxygen consumption measurement possesses a strong prognostic value in chronic heart failure. This parameter allowing notably the selection of patients for heart transplant. Nevertheless, sub maximal effort and beta blocker therapy tend to limit its prognostic value. The ventilatory response evaluated by the minute ventilation – carbon dioxide production linear regression slope during effort is generally considered to be a significant predictor of mortality and hospitalizations in HF population. An enhanced ventilatory response is correlated with a poorer prognostic. In addition, this parameter is not influenced by the intensity of the effort neither by the betablocker therapy. But, physiological determinants are not clear yet. Aim of our study is to confirm the important place of the slope in HF patient''s evaluation. [Copyright &y& Elsevier]

Abstract: Objective: The purpose of this review was to present an update of the anaesthesic management in patients with right ventricular failure (RVF). Data sources: All references obtained from the medical database Medline® related to the area and more specifically during the last five years were reviewed. Data synthesis: The preanaesthesic visit leads to identify the etiology of RVF, to evaluate the functional reserve of the patient, to plan complementary exams and to inform the patients about the risks associated with the perioperative period. During the peroperative period, the monitoring depends of the severity of the illness; however the invasive monitoring of the systemic blood pressure seems always necessary. Any hemodynamic instability should be avoided during the peri-operative period. Since the risk of death is maximal in the first days after the anaesthesia, the patient is ideally managed in intensive care during this period. Conclusion: Right ventricular failure is often misestimates. However, the perioperative morbidity and mortality of patients with RVF are important. In the perioperative period, the anaesthesiologist should identify patients at risk of right ventricular failure in order to adapt their management. [Copyright &y& Elsevier]

Natriuretic Peptides like BNP or NT Pro BNP are diagnostic and prognostic makers largely used in clinical practice. Ageing may increase these peptides, especially in case of comorbidities like renal failure or hypertension and require adjustment for age. Diagnostic value of natriuretic peptides seems however preserved in elderly people. [Copyright &y& Elsevier]

Abstract: We report a case of severe aortic bicuspid valve endocarditis, revealed by global cardiac failure without fever, in a 38-year-old man who had developed cerebral mycotic aneurysms nine months earlier. PCR analysis of the excised aortic valve and serological tests (even 9 months earlier) were positive for Bartonella henselae. A combination of intravenous then oral doxycyclin at 200mg/day and intravenous gentamycin at 90mg/day was given for 6 and 2 weeks respectively. The evolution was favorable on follow-up, 12 months after completion of the therapy. Only 49 cases of B. henselae endocarditis have been reported to date, none with associated mycotic aneurysm but most often located on the bicuspid aortic valve, and usually with severe valvular damage due to late diagnosis. [Copyright &y& Elsevier]

Abstract: Rhythm control or rate control are the 2 therapeutic strategies for atrial fibrillation (AF) management. Despite strong physiological and epidemiological data to support a rhythm control strategy, the results of the prospective studies, especially AFFIRM and RACE trials, did not demonstrate any superiority of a rhythm control versus a rate control strategy. The AF-CHF trial conducted in heart failure patients led to the same conclusions. In clinical practice, the therapeutic management is only driven by the patient symptoms. For rhythm control, antiarrhythmic drugs are still the first step before considering, in selected patients, ablative techniques. Treatment algorithms proposed in 2006 by the European society of cardiology are the references for patient management, treatment being individually optimized. [Copyright &y& Elsevier]