The Failing Heart - New Insights
Thursday, 06 November 2014
Medico-Chirurgical Hall
Professor Michael Frenneaux, Regius Professor of Medicine, University of Aberdeen
Notes
Minute of meeting of the Society held on 6th November 2014 in the Society's Hall, Foresterhill.
The President, Professor Mike Greaves, presided.
The President introduced Professor Michael Frenneaux, the Regius Professor of Medicine, University of Aberdeen who spoke on The Failing Heart - New Insights.
His talk was divided into two sections, staring with 'something old', i.e. Starling's Law (The Frank-Starling Law which says that the stroke volume of the heart increases in response to an increase in the volume of blood filling the heart).
Although major advances have been made in the treatment of heart failure, Prof Frenneaux said that present treatments, mostly aimed at the renin/angiotensin system, have reached about as far as they can go, and heart failure is still a major cause of morbidity and mortality. Going back to Starling's Law, he said that it does not apply in a failing heart because of pericardial restraints - a distended heart stretches the pericardium, thus reducing functional left ventricular pressure. Many illustrations were used to demonstrate this point and Prof Frenneaux described experiments which proved his explanation.
After talking about left ventricular pacing being a hopeful therapy which is being developed, he spoke briefly about 'diastolic heart failure' in which the left ventricle is normal.
He then moved onto 'something new' which related to energy use in the myocardium. The heart uses a lot of energy but it seems that the failing heart is deprived on energy and he spoke about possible causes including mitochondria using fat instead of glucose as their energy source. If one can stop fat getting into mitochondria then function should improve. The drug Perhexilene can do that and trials have shown it to be efficacious and it has been granted 'orphan drug' status in America. It is a difficult drug to use and some variants have been developed which look as if they may be safer and easier to use.
Professor Frenneaux then answered questions on the feasibility of left ventricular pacing (seemingly quite easy); the diagnosis of diastolic heart failure (difficult); whether removing the pericardium helps (it does not) and whether Perhexilene will reduce mortality (as yet unknown)
The President thanked Professor Frenneaux for his talk.
The meeting then reconvened in the foyer where Professor James Grieve laid a wreath at the Society's war memorial.