Understanding the pharmacology of heart failure

2021 ◽  
Vol 3 (10) ◽  
pp. 404-410
Author(s):  
Jamshid Easa ◽  
Najma Easa ◽  
Jacob Chappell ◽  
David Warriner
Keyword(s):  
Heart Failure ◽  
Water Retention ◽  
Healthcare Systems ◽  
Physical Symptoms ◽  
Clinical Syndrome ◽  
Western World ◽  
Significant Burden ◽  
Downward Spiral ◽  
Ventricular Filling ◽  
Symptoms And Signs

Heart failure (HF) is a common clinical syndrome with ever-increasing prevalence in the Western world. It is associated with extensive morbidity and mortality, as well as being a significant burden on global healthcare systems. It is due to impairment of ventricular filling or contraction, resulting in a constellation of physical symptoms and signs, primarily due to salt and water retention. An understanding of the pharmacological options to manage the condition is imperative to quickly alleviate symptoms and avert a rapidly progressive downward spiral, improving not only quality but also quantity of life.

Understanding the pharmacology of heart failure

2021 ◽  
Vol 32 (9) ◽  
pp. 363-368
Author(s):  
Jamshid Easa ◽  
Najma Easa ◽  
Jacob Chappell ◽  
David Warriner
Keyword(s):  
Heart Failure ◽  
Water Retention ◽  
Healthcare Systems ◽  
Physical Symptoms ◽  
Clinical Syndrome ◽  
Western World ◽  
Significant Burden ◽  
Downward Spiral ◽  
Ventricular Filling ◽  
Symptoms And Signs

The prevalence of heart failure is increasing worldwide. Jamshid Easa, Najma Easa, Jacob Chappell and David Warriner provide an overview of the pharmacology of the drugs used to manage the condition Heart failure (HF) is a common clinical syndrome with ever-increasing prevalence in the Western world. It is associated with extensive morbidity and mortality, as well as being a significant burden on global healthcare systems. It is due to impairment of ventricular filling or contraction, resulting in a constellation of physical symptoms and signs, primarily due to salt and water retention. An understanding of the pharmacological options to manage the condition is imperative to quickly alleviate symptoms and avert a rapidly progressive downward spiral, improving not only quality but also quantity of life.

Understanding the pathogenesis of heart failure

2021 ◽  
Vol 32 (2) ◽  
pp. 54-58
Author(s):  
Jamshid Easa ◽  
Jacob Chappell ◽  
David Warriner
Keyword(s):  
Heart Failure ◽  
Water Retention ◽  
Physical Symptoms ◽  
Left Ventricular ◽  
Clinical Syndrome ◽  
Common Type ◽  
Ventricular Failure ◽  
High Prevalence ◽  
Ventricular Filling ◽  
Symptoms And Signs

Heart failure is a complex clinical syndrome. Jamshid Easa, Jacob Chappell and David Warriner explain the pathogenesis behind the most common form of this condition Heart failure a complex clinical syndrome due to impairment of ventricular filling or contraction, resulting in a constellation of physical symptoms and signs, primarily due to salt and water retention. In this clinically focused review of the pathophysiology, we will summarise the main consequences of the most common type, left ventricular failure; knowledge of which is essential for those working in general practice due to the high prevalence of heart failure in the community and to aid understanding of the various pharmacotherapies that work to act on the pathological mechanisms.

Heart failure in an elderly population

2001 ◽  
Vol 11 (4) ◽  
pp. 311-321
Author(s):  
DN Carmichael ◽  
Michael Lye
Keyword(s):  
Heart Failure ◽  
Treatment Options ◽  
Clinical Syndrome ◽  
Point Of View ◽  
Diagnostic Challenge ◽  
The Common ◽  
Characteristic Features ◽  
The Many ◽  
Neuroendocrine Activation ◽  
Symptoms And Signs

Heart failure has been defined in many ways and definitions change over time. The multiplicity of definitions reflect the paucity of our understanding of the primary underlying physiology of heart failure and the many diseases for which heart failure is the common end-point. Fundamentally, heart failure represents a failure of the heart to meet the body’s requirement for blood supply for whatever reason. It is thus a clinical syndrome with characteristic features – not a single disease in its own right. The syndrome includes symptoms and signs of organ underperfusion, fluid retention and neuroendocrine activation. The syndrome arises from a range of possible causes of which ischaemic heart disease is the commonest. From the point of view of a clinician, the underlying pathology will determine treatment options and prognosis. The extensive range of possible aetiologies present a diagnostic challenge both to correctly identify the syndrome amongst all other causes of dyspnoea and to identify the aetiology, allowing optimization of treatment.

Heart Failure and Cardiomyopathies

2012 ◽  
Author(s):  
Barry L. Karon ◽  
Naveen L. Pereira
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Clinical Syndrome ◽  
Fluid Retention ◽  
The Body ◽  
Precipitating Factors ◽  
Dynamic Nature ◽  
Correct Treatment ◽  
Ventricular Filling

Heart failure is a clinical syndrome characterized by the inability of the heart to maintain adequate cardiac output to meet the metabolic demands of the body while still maintaining normal or near-normal ventricular filling pressures. Heart failure may be present at rest, but often it is present only during exertion as a result of the dynamic nature of cardiac demands. For correct treatment of heart failure, the mechanism, underlying cause, and any reversible precipitating factors must be identified. Typical manifestations of heart failure are dyspnea and fatigue that limit activity tolerance and fluid retention leading to pulmonary or peripheral edema. The most recent proposed categorization divided the cardiomyopathies into primary and secondary cardiomyopathies, and the primary disorders are further subdivided as genetic, acquired, or mixed. Although this proposal takes into account our progressive understanding of this heterogeneous group of disorders, the previous phenotypic classification of dilated, hypertrophic, and restrictive diseases still provides utility in day-to-day understanding and management of these disorders.

scholarly journals Peritoneal Dialysis for Heart Failure

2015 ◽  
Vol 35 (6) ◽  
pp. 645-649 ◽  
Author(s):  
Harish Puttagunta ◽  
Stephen G. Holt
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Peritoneal Dialysis ◽  
Randomized Trials ◽  
The Elderly ◽  
Healthcare Systems ◽  
Heart Failure Patients ◽  
Significant Burden ◽  
Survival And Growth ◽  
Combined Strategy

Heart failure (HF) is a common and important cause of morbidity and mortality in the elderly, imposing a significant burden on healthcare systems. Better management of ischemic heart disease has resulted in increased survival and growth in the number of prevalent heart failure patients, but co-existing renal impairment complicates management and limits traditional therapeutic options. Ultrafiltration (UF) techniques have shown promise in the treatment of diuretic-resistant HF, but the early successes of extracorporeal treatments has not been confirmed by randomized trials. Peritoneal dialysis (PD) may be cheaper and provide more effective UF therapy in selected patients and this review examines the issues surrounding the use of PD for such patients. Whist many nephrologists are enthusiastic about the use of this technique, making a more cogent case for PD in this setting for cardiologists is likely to need a combined strategy of demonstrating improvement in individual cases and further study of potential medicoeconomic benefits.

scholarly journals Risk Stratification for Sudden Cardiac Death in Heart Failure

2019 ◽  
Vol 5 (1 (P)) ◽  
pp. 1
Author(s):  
Hendry Purnasidha Bagaswoto
Keyword(s):  
Heart Failure ◽  
Sudden Cardiac Death ◽  
Risk Stratification ◽  
Cardiac Death ◽  
Clinical Syndrome ◽  
Pump Failure ◽  
Failure Risk ◽  
Clinical Challenge ◽  
Symptoms And Signs

Heart failure (HF) is a complex clinical syndrome in which structural / functional myocardial abnormalities result in symptoms and signs of hypoperfusion and/or pulmonary or systemic congestion at rest or during exercise. More than 80% of deaths in patients with HF recognize a cardiovascular cause, with most being either sudden cardiac death (SCD) or death caused by progressive pump failure. Risk stratification of SCD in patients with HF represents a clinical challenge. This review will give an update of current strategies for SCD risk stratification in HF.

scholarly journals Prevalence of left bundle branch block and CRT treatment in a large regional unselected ECG database

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Lind ◽  
P Gatti ◽  
I Kristjansdottir ◽  
F Gadler
Keyword(s):  
Heart Failure ◽  
Real Life ◽  
Signs And Symptoms ◽  
Cardiac Resynchronisation Therapy ◽  
Clinical Syndrome ◽  
University Hospital ◽  
Western World ◽  
Heart Failure Patients ◽  
National Budget ◽  
Ecg Database

Abstract Introduction Heart failure is a clinical syndrome in which signs and symptoms are due to functional and/or structural abnormalities of the heart which prevent the necessary supply of oxygenated blood or do so at the expense of high filling pressures. It has a prevalence of 1–2% in the western world and increasing prevalence with increasing age. While the prognosis for coronary heart disease has improved significantly, the same does not apply for heart failure, perhaps because some effective treatment methods have not been sufficiently implemented in health care. One effective but underutilized heart failure treatment is the cardiac resynchronisation therapy (CRT), that coordinates the contraction of the left and right ventricles via a pacemaker (PM). CRT treatment is an evidence based treatment recommended by among other the ESC guidelines for heart failure. Clinical studies have suggested decreases in mortality, hospitalization, morbidity and improvements in quality of life for heart failure patients receiving a CRT. Purpose To find a new clinical pathway to improve CRT implementation and to evaluate if it might be optimized through ECG-based surveillance and thus improving prognosis. Methods In a population of approximately 2.5 million people in our region we investigated the University Hospital's ECG database between 2000 and 2018. During which time 432 108 adult patients with 1 482 489 ECG's presented to the hospital. We searched and found 5 511 unique patients with the following ECG criteria: QRS ≥150 ms at any time, LBBB and Non pace. According to the Pacemaker Registry we excluded 771 patients that had previously received a PM/CRT. We also identified patients with diagnosis of heart failure by using the ICD-10 codes (I42.0 and I50). Results Our final cohort consists of 4 740 patients. The median age was 75 (19–112) years, 34.5% were female and 14.9% were subsequently implanted with a CRT (60% with CRT-D). The median time to CRT implantation from the first ECG with LBBB was 244 (IQR 994) days. Of the 4 740 patients 20.6% had a previous hospitalistion for heart failure with a median delay from the hospitalisation to CRT implantation of 5 (IQR 5.4) years. Conclusions Our observational data from a large real-life regional ECG database show there is a considerable number of heart failure patients that could benefit from CRT treatment. Using an existing ECG database could be useful in finding patients with indication for CRT implantation. This could possibly influence morbidity and mortality in a regional heart failure population by minimizing the delay of CRT treatment. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Karolinska University Hospital Research Fund

Comprehensive Guideline for Care of Patients With Heart Failure

2014 ◽  
Vol 25 (2) ◽  
pp. 151-162
Author(s):  
Denise Buonocore ◽  
Elizabeth Wallace
Keyword(s):  
Heart Failure ◽  
American Heart ◽  
Heart Association ◽  
The United States ◽  
Clinical Syndrome ◽  
American Heart Association Guideline ◽  
United States Today ◽  
Patients With Heart Failure ◽  
Ventricular Filling

Heart failure (HF) is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. More than 5.1 million people are living with HF in the United States today. This number will continue to rise with the increase in the aging population. With so many people living with HF, nurses need to be well versed on how best to care for them. The 2013 American College of Cardiology Foundation/American Heart Association guideline for the management of HF is a comprehensive guide for all clinicians caring for patients with HF. The updated guideline was developed to assist providers in decision making in the diagnosis and treatment of HF. The goals of the writing committee were to improve quality of care for patients with HF, optimize their outcomes, and improve the efficient use of various resources in the treatment of patients with HF.

scholarly journals Restrictive Cardiomyopathies: The Importance of Noninvasive Cardiac Imaging Modalities in Diagnosis and Treatment—A Systematic Review

2017 ◽  
Vol 2017 ◽  
pp. 1-14 ◽  
Author(s):  
Aidonis Rammos ◽  
Vasileios Meladinis ◽  
Georgios Vovas ◽  
Dimitrios Patsouras
Keyword(s):  
Heart Failure ◽  
Tissue Characterization ◽  
Systolic Function ◽  
Treatment Options ◽  
Restrictive Cardiomyopathy ◽  
Noninvasive Cardiac Imaging ◽  
Right Ventricular Filling ◽  
Electrocardiographic Findings ◽  
Ventricular Filling ◽  
Symptoms And Signs

Restrictive cardiomyopathy (RCM) is the least common among cardiomyopathies. It can be idiopathic, familial, or secondary to systematic disorders. Marked increase in left and/or right ventricular filling pressures causes symptoms and signs of congestive heart failure. Electrocardiographic findings are nonspecific and include atrioventricular conduction and QRS complex abnormalities and supraventricular and ventricular arrhythmias. Echocardiography and cardiac magnetic resonance (CMR) play a major role in diagnosis. Echocardiography reveals normal or hypertrophied ventricles, preserved systolic function, marked biatrial enlargement, and impaired diastolic function, often with restrictive filling pattern. CMR offering a higher spatial resolution than echocardiography can provide detailed information about anatomic structures, perfusion, ventricular function, and tissue characterization. CMR with late gadolinium enhancement (LGE) and novel approaches (myocardial mapping) can direct the diagnosis to specific subtypes of RCM, depending on the pattern of scar formation. When noninvasive studies have failed, endomyocardial biopsy is required. Differentiation between RCM and constrictive pericarditis (CP), nowadays by echocardiography, is important since both present as heart failure with normal-sized ventricles and preserved ejection fraction but CP can be treated by means of anti-inflammatory and surgical treatment, while the treatment options of RCM are dictated by the underlying condition. Prognosis is generally poor despite optimal medical treatment.

Heart Failure and Cardiomyopathies

2016 ◽  
pp. 59-74
Author(s):  
Farris K. Timimi
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Clinical Syndrome ◽  
Fluid Retention ◽  
Optimal Treatment ◽  
The Body ◽  
Precipitating Factors ◽  
Dynamic Nature ◽  
Peripheral Edema ◽  
Ventricular Filling

Heart failure is a clinical syndrome characterized by inability of the heart to maintain adequate cardiac output to meet the metabolic demands of the body while still maintaining normal or near-normal ventricular filling pressures. Heart failure may be present at rest, but often it is symptomatic only during exertion due to the dynamic nature of cardiac demands. For the optimal treatment of heart failure, the mechanism, underlying cause, and any reversible precipitating factors must be identified. Typical manifestations of heart failure are dyspnea and fatigue limiting activity tolerance and fluid retention leading to pulmonary or peripheral edema.

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