Day 2 :
University of Toledo Medical Center, USA
Time : 09:10-09:50
William J Rowe is a board certified Specialist in Internal Medicine. He completed his MD at University of Cincinnati and was in private practice in Toledo, Ohio for 34 years. He was a former Assistant Clinical Professor of Medicine at University of Ohio, School of Medicine. Out of four space syndromes, he has published two: The Apollo 15 Space Syndrome and Neil Armstrong Syndrome.
Neil Armstrong syndrome triggered by very common earth related magnesium (Mg) deficits, invariably with spaces flight (SF); invariable dehydration with exercise-induced sweating with Mg loss and through kidneys; leaks of plasma through oxidative stress-induced defective capillaries; loss of thirst mechanism; in turn, angiotensin, catecholamine (C) elevations to twice earth levels when supine; vicious cycles with Mg ion deficits; can trigger C cardiomyopathy i.e. acute temporary heart failure. Normal earth CO2 levels about 0.03% with SF, levels can be 0.5-7% as on Mir; this, postulated to trigger calcium (Ca) overload with in turn coronary vasospasm, injuries to mitochondria along with impairment in telomere function; its synthesis is dependent upon Mg and in turn, decreased cardiac function. Since Mg required for thermoregulation was intensified by SF-exercise for at least 2 hours exercise/day; invariable SF mal-absorption with Mg levels reduced to p<0.0001 even though serum Mg lacks sensitivity. Neil Armstrong informed Houston twice at 4 minutes interval, of shortness of breath with heart rate up to 160 (tachycardia conducive to oxidative stress) with marked reduction to 60, half hour before pacific-splashdown over three days later; severe thirst, quenched with in turn, reduced postulated high C. Mg is powerful antioxidant and Ca blocker. Severe dyspnea, thirst, tachycardia; the latter, corrected by water replenishment during three days back to Earth; one of only four- SF syndromes was observed; applicable to Earth in post-menopausal women, particularly if taking Ca supplements which reduces Mg absorption; marathoners at finish line; in tropics with water shortages; may be corrected quickly with I.V fluids or subcutaneous Mg.
Sheba Medical Center, Israel
Keynote: The stress of a patient's heart; heart rehabilitation in patients with systolic and diastolic heart failure
Time : 09:50-10:30
Yehuda Adler is Director of Development of Medical Resource, Director of Internship Committee, Director of the Talpiot Medical Leadership Program (a revolutionary program to build medical leadership in Israel), and Director of health professions at the Chaim Sheba Medical Centre, Israel. He is a member of the National Council for Prevention and Treatment of Cardiovascular Diseases at the Ministry of Health in Israel. He is also a Vice Chair of the Nucleus, The ESC's Committee for Myocardial and Pericardial diseases. He wrote the ESC Guidelines for pericardial disease in 2005 and chaired the ESC Guidelines for pericardial disease in 2015. In the past, he served as General Director at Misgav-Ladach Hospital, Jerusalem, Israel. He has published over 200 original articles in leading professional medical and research journals throughout the world and is an active participant and speaker in international scientific meetings.
There are limited contemporary data regarding the association between improvement in cardiovascular fitness in heart failure (HF) patients who participate in exercise training and the risk for subsequent hospitalizations. Shown in the presentation are the connections between exercise training and skeletal muscle in CHF; the anti-inflammatory effects of exercise training in CHF and the hemodynamic effects of exercise training in CHF (which includes general hemodynamics, endothelial function and small vessels). In addition, pathobiological pathways induced by exercise training in patients with heart failure are displayed. The essential details from research done by David J. Whellan (Jefferson Medical College, Philadelphia, PA) and Christopher M. O'Connor (Duke University Medical Center, Durham, NC) titled: “Efficacy and safety of exercise training as a treatment modality in patients with chronic heart failure” are displayed. Results of a randomized controlled trial investigating outcomes of exercise training (HF-ACTION) are shown as well. Cardiac insufficiency with preserved systolic function; prevailing manifestation of evaluation diastolic impairment using ratio of volume/pressure and pharmaceutical treatment was checked or is being checked on perspective oriented projects. Results regarding exercise capacity, diastolic function & la remodeling and the quality of life are reviewed. In summary, the colleague team work that plays an important role in the field is reflected. Heart failure patients participating in exercise training for improvement of cardiovascular fitness are associated with reduced risk of mortality or hospitalization during long-term follow-up, independent of their baseline fitness.
Sheikh Khalifa Medical City, UAE & Cleveland Clinic, USA
Time : 10:45-11:25
Samer Ellahham has served as Chief Quality Officer at Shaikh Khalifa Medical City since 2009. In his role, he has led the development of a quality and safety program that has been highly successful and visible and has been recognized internationally by a number of awards. As Chief Quality Officer and Global Leader, he has focus on ensuring that that implementation of this best practices leads to breakthrough improvements in clinical quality and patient safety. He is the recipient of the Quality Leadership Award from the Global Awards for Excellence in Quality and Leadership and the Business Leadership Excellence Award from the World Leadership Congress. He was nominated in 2015 for SafeCare magazine Person of the Year. He is Certified Professional in Healthcare Quality (CPHQ). He is a recognized leader in quality, safety, and the use of robust performance improvement in improving healthcare delivery.
Nearly half of all patients with heart failure have a normal ejection fraction (EF). The prevalence of this syndrome, termed heart failure with preserved ejection fraction (HFpEF), continues to increase likely because of the increasing prevalence of common risk factors, including older age, female gender, hypertension, renal dysfunction, metabolic syndrome and obesity. In contrast to heart failure with reduced ejection fraction (HFrEF), no treatment has been proven in pivotal clinical trials to be effective for HFpEF, largely because of the pathophysiological heterogeneity that exists within the broad spectrum of HFpEF. This syndrome was historically considered to be caused exclusively by left ventricular diastolic dysfunction, but research has identified several other contributory factors, including limitations in left ventricular systolic reserve, systemic and pulmonary vascular function, nitric oxide bioavailability, chronotropic reserve, right heart function, autonomic tone, left atrial function and peripheral impairments. Multiple individual mechanisms frequently coexist within the same patient to cause symptomatic heart failure, but between patients with HFpEF the extent to which each component is operative can differ widely, confounding treatment approaches. Clinical trials have not yet identified effective treatments for HFpEF. Incomplete understanding of the pathophysiology of HFpEF, the likelihood that there is substantial pathophysiologic heterogeneity among affected patients and the interplay of various risk factors has all been barriers in the development of effective treatments. Ongoing research initiatives are critically important as there is a rapid increase in number of patients with this form of heart failure.
Learning Objectives: Objectives are to: Demonstrate the association between heart failure with preserved ejection fraction (HFpEF) and survival; given a patient with heart failure (HF), recognize HFpEF on the basis of clinical signs and symptoms, physical examination, echocardiography, and radiographic findings; classify patients at high risk of hospitalization and mortality through assessing risk factors, clinical presentation and interpretation of biomarkers; distinguish the clinical presentation, diagnosis and treatment strategies of HFpEF from those of HF with reduced ejection fraction; given a patient with HFpEF, develop an individualized treatment plan based on current evidence; assess the potential role of future pharmacotherapies for HFpEF.