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Pathophysiology and Clinical Evaluation of the Patient with Acute Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Georgios Bakosis, Vasiliki Bistola, Eftyhia Polyzogopoulou, John Parissis
Acute heart failure is a potentially life-threatening clinical syndrome which requires prompt diagnosis and initiation of treatment to prevent dismal outcomes. Understanding its pathophysiology is a key element toward this goal. Congestion is the hallmark of AHF, either due to “cardiac” failure and fluid retention or due to “vascular” failure, resulting in fluid redistribution. Myocardial loss leading to cardiac pump incompetence, hemodynamic compromise, and end-organ dysfunction (cardiogenic shock) is a rarer but much more severe contributing mechanism. Frequently, though, several mechanisms coexist in the same patient, leading to complex clinical manifestations and often making differential diagnosis challenging. An in-depth clinical evaluation is required to confirm the diagnosis, assess its severity, and identify and treat possible precipitants. A detailed medical history, along with physical examination, with specific interest in early detection of signs and/or symptoms of congestion and organ hypoperfusion, is recommended, while natriuretic peptide testing, combined with cardio-thoracic echocardiography, can promote early diagnosis and guide therapy already in the emergency room.
The patient with acute cardiovascular problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
There are many reasons why the heart loses the ability to adequately supply oxygenated blood to the target organs, and this is reflected by the type of heart failure that exists and which side of the heart has failed. Acute heart failure occurs when there is a rapid onset of heart failure symptoms that, due to their life-threatening nature, require urgent treatment in hospital, and this is discussed later in this chapter.
Management strategies
Published in Gregory YH Lip, Atrial Fibrillation in Practice, 2020
Patients who present with acute-onset AF who are haemodynamically stable and asymptomatic, or if they present later than 48 hours after the onset, can initially be treated with a strategy of heart rate control and anticoagulation, as an alternative to cardioversion, allowing time for assessment and evaluation of the patient. In either case effective anticoagulation in the form of heparin and/or warfarin should be initiated to decrease the risk of thromboembolic complications. Associated complications should be managed accordingly, for example, acute heart failure should be treated with diuretics.
Non-HACEK gram-negative bacilli endocarditis: a multicentre retrospective case-control study
Published in Infectious Diseases, 2023
Marine Sebillotte, David Boutoille, Charles Declerck, Jean-Philippe Talarmin, Adrien Lemaignen, Caroline Piau, Matthieu Revest, Pierre Tattevin, Marie Gousseff
This cohort of 77 non-HACEK GNB IE is the largest to date, followed by the Prospective Multicenter Italian Endocarditis Study (PMIES) cohort (n = 58) [13], and the International Collaboration on Endocarditis (ICE) cohort (n = 49) [4]. Our findings are in line with previous cohorts regarding increased risk in patients with comorbidities (especially haemodialysis and malignancies), with recent invasive procedure and, to a lesser extent, IVDUs. We confirmed the high prevalence of acute heart failure at diagnosis, and the dismal prognosis. Our cohort differs from previous cohorts regarding the low proportion of non-fermenting GNB IE: 9%, vs. 19–30% in most cohorts of non-HACEK GNB IE [4,5,13,22,23], up to 78% in USA cohorts [24–26]. This may be in part related to large differences in the proportion of IVDUs among non-HACEK GNB IE worldwide, in line with striking heterogeneities in harm reduction policies and access to needle-exchange programs: Indeed, more than one-third of non-HACEK GNB IE in USA cohorts occur in IVDUs [8,26], as compared to <10% in other cohorts [4,5,22], as in ours. Of note, S. marcescens was the main non-HACEK GNB responsible for IE among IVDUs in our cohort.
Right atrial reservoir strain and right ventricular strain improves in patients recovered from hospitalisation for non-severe COVID-19
Published in Acta Cardiologica, 2023
Mehmet Rasih Sonsoz, Gulden Guven, Ufuk Yildiz, Atilla Koyuncu, Ozlem Altuntas Aydin, Gokhan Kahveci
Retrospective analyses of the echocardiograms collected during hospitalisation and thus during acute disease (performed 24 h after admission) were compared with those collected at follow-up in our outpatient clinic (performed 6 [range, 5–7] months after discharge). Exams were performed during acute disease upon cardiology consultation for the differential diagnosis of acute heart failure, acute coronary syndrome and acute myocarditis. The patient’s cardiac symptoms were: shortness of breath in 58% (n = 25), chest pain in 40% (n = 17), and/or palpitations in 26% (n = 11). At follow-up, no patient showed signs and/or symptoms of acute infection, but 35% (n = 15) had shortness of breath, 21% (n = 9) had persistent chest pain, 42% (n = 18) had effort intolerance, and 23% (n = 10) had palpitations. Four of the patients (10%) were asymptomatic.
Angiotensin converting enzyme inhibitors and angiotensin II receptor blockers and outcomes in patients with acute decompensated heart failure: a systematic review and meta-analysis
Published in Expert Review of Cardiovascular Therapy, 2021
Jerald Pelayo, Kevin Bryan Lo, Eric Peterson, Carly DeFaria, Atif Nehvi, Ricardo Torres, Muhammad Haisum Maqsood, Minaam Farooq, Roy O. Mathew, Janani Rangaswami
This systematic review and meta-analysis is the first to our knowledge to substantiate the theoretical basis of the harms associated with interrupting ACEi/ARBs which are mechanistically meant to mitigate the core pathogenesis of ADHF – the renin-angiotensin-aldosterone system (RAAS) activation. In hospitalized patients being managed for acute heart failure with decongestive therapy while on goal-medical directed therapy, it is not uncommon to observe clinicians including cardiologists and nephrologists discontinue beta-blockers, ACEi/ARBs or angiotensin receptor-neprilysin inhibitor (ARNI) reflexively. Hypotension, hyperkalemia and/or azotemia are known worrisome triggers. While this common clinical practice seem rational, this equally and potentially heralds poor long term clinical outcomes in terms of mortality and readmissions, more particularly among HFrEF population.