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Advanced Therapeutic Options in Acute Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Tiffany Dong, Aditi Nayak, Alanna Morris
Therapy for patients presenting with symptoms of acute decompensated heart failure (ADHF) is largely driven by presentation evidence of congestion and the underlying hemodynamic profile. Those who present as “warm and wet” are defined by symptoms of congestion without evidence of hypoperfusion,1 for which diuresis remains the cornerstone of therapy. Alternatively, those who present as “cold and wet” are not only congested but also have evidence of hypoperfusion resulting in end-organ dysfunction, while a minority of patients will present as “cold and dry” with no evidence of congestion, but evidence of decreased end-organ perfusion. Treatment for these phenotypes consists of diuretics to relieve congestion when present, as well as chemical and mechanical support to restore end-organ perfusion.
Diagnostic Approach to Acute Kidney Injury in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Sonali Gupta, Divyansh Bajaj, Sana Idrees, Joseph Mattana
The presence of numerous connectors between the kidney and heart predisposes patients with heart disease to developing AKI. Common risk factors for development of AKI in cardiovascular patients include advanced age, myocardial infarction, stroke, heart failure, hypertension, diabetes mellitus, advanced New York Heart Association heart failure functional class, and previous hospitalizations for heart failure [10]. Acute kidney injury in the setting of acute decompensated heart failure, a form of Type 1 cardiorenal syndrome, is characterized by a hemodynamically mediated decrease in RBF, compounded by increased sympathetic output, renin-angiotensin system activation, and increased release of inflammatory mediators among various mechanisms [11,12]. Cardiac interventions themselves may predispose to AKI through mechanisms, including exposure to iodinated radiocontrast. Patients undergoing such procedures often have pre-existing comorbidities, including diabetes, hypertension, and use of medications such as diuretics that may make them especially vulnerable to contrast induced AKI. Acute kidney injury has been reported to occur in about 10% of patients after percutaneous coronary angiography and has been associated with increased cardiovascular morbidity and mortality [13].
Pharmacological therapy
Published in ILEANA PIÑA, SIDNEY GOLDSTEIN, MARK E DUNLAP, The Year in Heart Failure, 2005
KIRKWOOD ADAMS, HERBERT PATIERSON
The treatment of acute decompensated heart failure remains of significant interest, as this major public health problem continues to present a major morbidity and mortality burden and economic consequence for patients with heart failure. Knowledge concerning nesiritide, one of the few therapies for acute heart failure supported by randomized clinical trial results, continues to accumulate. Several studies on diverse aspects of this drug continue to testify to its clinical utility. Finally, new data on inotropic agents and a number of investigational pharmaceutical agents are reviewed. Digoxin remains a controversial drug for many, but new data suggest that optimal dosing may help to improve outcomes on this therapy. New results with antagonism of vasopressin and endothelin-1 raise the possibility that inhibition of these neurohormones may produce clinical benefits in patients with heart failure. All of the above work serves to highlight the continued public health and clinical importance of heart failure, a syndrome which still claims too many lives and impairs quality oflife too often. Application of new information reviewed in this section will provide additional strategies for the more effective treatment of this syndrome.
Association between tricuspid annular systolic velocity and poor short-term prognosis in patients with acute decompensated heart failure
Published in Annals of Medicine, 2022
Kai Zhao, Jiang Zhou, Jing Tao Guo, Cai Hong Wu, Sen Lin Li, Qi Zhang, Xiang Tian, Wei Chao Shan, Zhen Jiang Ding, Lan Suo Yuan, Qun Zheng, Xiao Li Gao, Nan Guo, Hong Sen Tian, Qing Min Wei, Xi Tian Hu, Ying Kai Cui, Xue Geng, Qian Wang, Wei Cui
Acute decompensated heart failure (ADHF) is characterized by a relatively swift change in the signs or symptoms of heart failure (HF), thus leading to unscheduled therapy or hospitalization [1,2]. Burgeoning evidence indicates that the natural history of ADHF is featured by a marked increase in recurrent post-discharge events as opposed to high in-hospital mortality especially within 3 months, which renders this condition as one of leading causes for hospitalization in elderly patients both in developed and developing countries [3–8]. However, a growing number of studies have demonstrated that in spite of the unremitting efforts to reduce rehospitalizations for ADHF, there appears to be only a slight impact on the corresponding readmissions [9,10]. Therefore, clinicians or researchers should particularly fixate on factors associated with the undesirable recent prognosis of ADHF in order to identify the high-risk patients and subsequently provide more tailored as well as comprehensive strategies at preventing further cardiovascular events.
The pathophysiology and management of diuretic resistance in patients with heart failure
Published in Hospital Practice, 2022
Steven G. Chrysant, George S. Chrysant
Diuretic resistance to the treatment of patients with CHF is common ranging between 20% and 50% of patients with advanced CHF, especially in the presence of renal functional impairment. Among the diuretics used, loop diuretics are the line of therapy with furosemide being the most commonly employed, although other loop diuretics like bumetanide and torsemide are more potent and longer acting, like torsemide. If resistance to loop diuretics persists after the use of maximal doses ranging from 200 to 300 mg/day, the resistance can be overcome with the addition of other diuretics like thiazide and thiazide-like, mineralocorticoid receptor antagonists (MRAs), as well as the sodium-glucose co-transporter 2 (SGLT2) inhibitors acting at different segments of the renal tubule and have complementary effects. Other drugs used in acute decompensated heart failure include dopamine, nesiritide, and the vasopressin-2 inhibitor tolvaptan. This latter drug is particularly useful in patients with CHF and diuretic-induced hyponatremia, because they increase the free water clearance and improve the hyponatremia.
A giant left atrial myxoma causing mitral valve pseudostenosis – a mimicker
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Basel Abdelazeem, Hafiz Khan, Hameem Changezi, Ahmad Munir
CM is a rare condition with an incidence of 0.5 per one million annually [1]. Although it is a benign tumor, it can result in potentially life-threatening conditions. A detailed history and physical examination are crucial for early diagnosis. Cardiovascular symptoms, including chest pain, syncope, dyspnea, and angina, are the most common features in around 67% of the patients, out of which 28% can present with acute decompensated heart failure (ADHF) [4]. Constitutional symptoms, including fever, malaise, arthralgia, and myalgia, are the second most common presentation in around 34%, while the embolic symptoms constitute up to 29% of the patients. Left-sided CM embolizes systemically to cerebral circulation (most common site, up to 30–40% of the patients), kidneys, and lower extremities, while the right-sided CM embolization occurs to pulmonary circulation [5,6]. In an asymptomatic patient, CM can be an incidental finding on imaging.