scholarly journals Management of a patient with terminal chronic heart failure.

2018 ◽  
Vol 96 (3) ◽  
pp. 273-276
Author(s):  
N. A. Kosheleva ◽  
Elena Yu. Ponomareva ◽  
D. S. Sedov
Keyword(s):  
Heart Failure ◽  
Drug Therapy ◽  
Chronic Heart Failure ◽  
Heart Transplantation ◽  
Dilated Cardiomyopathy ◽  
Patient Management ◽  
Clinical Case ◽  
Clinical Manifestations

The presented clinical case describes the development of diffuse myocarditis in a 31-year-old man with the outcome of dilated cardiomyopathy and terminal chronic heart failure, resistant to drug therapy that required heart transplantation. Discussed aspects of diagnosis, clinical manifestations, tactics of patient management and indications for heart transplantation.

scholarly journals The ST2 diagnostic value in selection of patients for heart transplantation and post-transplant period

2019 ◽  
Vol 40 (1) ◽  
pp. 4-11
Author(s):  
A. S. Nikonenko ◽  
O. O. Tanska
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Cardiovascular Diseases ◽  
Chronic Heart Failure ◽  
Heart Transplantation ◽  
Prognostic Value ◽  
Clinical Manifestations ◽  
Mechanical Damage ◽  
Risk Of Death ◽  
Diagnostic And Prognostic Value

Purpose of the study. Study ST2 diagnostic marker in the development and severity of heart failure, evaluation of transplant status and the risk of developing a rejection crisis, as well as the risk of death in patients with cardiovascular disease.Material and methods. There were 41 patients under observation. The cases were conventionally divided into two groups: the first group of patients with chronic heart failure (n = 28), and the control group who performed orthotopic transplantation of the heart (n = 13).Results and discussion. These results suggest that ST2 is a real marker of chronic heart failure or a good predictor of mortality in decompensated patients. Changes in ST2 levels in patients after orthotopic cardiac transplantation may be potentially useful in detecting acute cellular rejection, as well as in controlling rejection therapy. The article is devoted to the analysis of the prognostic role of the ST2 biomarker in the pre and post-transplantation period. ST2 is one of the most promising diagnostic markers for the development and severity of heart failure, as well as the risk of death in patients with cardiovascular disease. ST2 is expressed in cardiomyocytes in response to pathological processes and various mechanical damage in the heart, which allows to diagnose cardiovascular diseases even before clinical manifestations. It is likely that ST2 level measurement of heart transplantation may have a diagnostic and prognostic value when evaluating the graft state and the risk of developing rejection.Conclusions. ST2 is one of the most promising diagnostic markers of development and severity of heart failure, as well as the risk of death in patients with cardiovascular disease. ST2 is expressed in cardiomyocytes in response to pathological processes and various mechanical damage in the heart, which allows to diagnose cardiovascular diseases even before clinical manifestations. Measuring the level of ST2 for heart transplantation may have a diagnostic and prognostic value in evaluating the condition of the graft and the risk of developing rejection. Keywords:heart failure, ST2, heart transplantation, rejection crisis.

scholarly journals Use of Sacubitril/Valsartan in a Chronic Heart Failure Patient with Reduced Ejection Fraction Accompany Dilated Cardiomyopathy and Myocardial Indensification: A Case Report

2020 ◽  
Author(s):  
Hengfen Dai ◽  
Yan Zhang ◽  
Jingwen Xiao
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Heart Transplantation ◽  
Dilated Cardiomyopathy ◽  
Clinical Prognosis ◽  
Common Cause ◽  
Reduced Ejection Fraction ◽  
Neuroendocrine Response

Abstract Rationale: Dilated cardiomyopathy (DCM) is a progressive cardiac disease characterized by ventricular dilation and contractile dysfunction and is the third most common cause of heart failure and the most common cause of heart transplantation. Heart failure (HF) and atrial fibrillation (AF) often coexist and share a mutually beneficial relationship. The presence of atrial fibrillation increases the tendency for heart failure, which can worsen its severity and increase the risk of stroke. DCM、AF and HF are causal to each other in pathophysiological view. However, how these pathogens translates upon acute decompensation heart failure(ADHF) is unknown. Control acute attack of chronic heart failure is the first step of treatment.Case summary: Herein, we described a 68-year-old man with acute decompensated heart failure (ADHF) with severe DCM and atrial fibrillation who was treated with Sacubitril/Valsartan and had a reduced ejection fraction. The patient’s echocardiography features had a significant improvement under taking Sacubitril/Valsartan. Sacubitril/Valsartan may act as an intermediary that balancing of the good and the bad neuroendocrine response.Discussion: DCM is a major cardiomyopathy and a major cause of heart transplantation. DCM’s clinical prognosis is poor, additionally, along with myocardial indensification, early diagnosis and treatment is helpful to prolong the patients' life. The emergence of Sacubitril/Valsartan represents the advent of a new strategy for treating HFrEF. Its beneficial effects are related in part, at least, to an improvement of echocardiographic features and positive modulation of the neuroendocrine response to HF.

scholarly journals Heart Transplantation as a Treatment Method for Refractory Heart Failure due to Post-myocarditis Dilated Cardiomyopathy: a Clinical Case

2019 ◽  
Vol 18 (2) ◽  
pp. 125-133
Author(s):  
Larisa A. Balykova ◽  
Elena I. Naumenko ◽  
Nataljya V. Ivyanskaya ◽  
Yulia A. Petrushkina ◽  
Ekaterina A. Vlasova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Dilated Cardiomyopathy ◽  
Clinical Case ◽  
Treatment Method ◽  
Circulatory Support ◽  
Chronic Cardiac Failure ◽  
Refractory Heart Failure ◽  
Life Threatening ◽  
Proper Analysis

Background. Implementation of mechanical circulatory support and heart transplantation technologies in paediatric clinical practice is changing approaches of diagnostics and treatment of heart failure (HF) in children. The experience of carrying out such operations in Russian Federation is extremely limited until recently due to absence of legal mechanisms of people declaration of intention recording about postmortal use of organs for transplantation.Clinical Case Description. The rare clinical case of drug-refractory (cardiotonic agents and cardioverter defibrillator implantation) chronic cardiac failure caused by post-myocarditis dilated cardiomyopathy (DCM) which demanded heart transplantation. Postoperative course, specific and non-specific complications, diagnostics and correction approaches are described.Conclusion. In the absence of proper analysis of non-specific slight symptoms myocarditis can progress to DCM and be complicated by development of refractory HF. The only method of sustaining child’s life in such case is heart transplantation which is connected with high risk of numerous and life-threatening complications.

scholarly journals EFFICACY OF DRUG THERAPY OF CHRONIC HEART FAILURE IN YOUNG CHILDREN WITH DILATED CARDIOMYOPATHY

2019 ◽  
Vol 22 (4) ◽  
pp. 219-225
Author(s):  
O. P. Zharova ◽  
Elena N. Basargina ◽  
A. P. Fisenko ◽  
L. A. Gandaeva ◽  
Yu. V. Derevnina
Keyword(s):  
Heart Failure ◽  
Drug Therapy ◽  
Chronic Heart Failure ◽  
Young Children ◽  
Dilated Cardiomyopathy ◽  
High Efficiency ◽  
Beta Blockers ◽  
Combined Therapy ◽  
Aldosterone Antagonists ◽  
Active Approach

Dilated cardiomyopathy in children is a very serious disorder with a poor outcome. However, clinical practice has shown that young children have a higher capability to recover cardiac function, which requires an active approach to the prescription of drug therapy. Currently, the combined therapy of chronic heart failure, including ACE inhibitors, beta-blockers, aldosterone antagonists, diuretics, demonstrates high efficiency in reducing the severity of heart failure symptoms, and in improving or stabilizing laboratory and instrumental parameters. Early and adequate administration of drug therapy can improve the prognosis of the disease and prevent an adverse outcome.

scholarly journals AB0249 POSITIVE EFFECT OF ANTIRHEUMATIC THERAPY ON THE COURSE OF CHRONIC HEART FAILURE IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1424.3-1425
Author(s):  
I. Kirillova ◽  
D. Novikova ◽  
T. Popkova ◽  
Y. Gorbunova ◽  
E. Markelova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Left Ventricle ◽  
Disease Activity ◽  
Diastolic Function ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Antirheumatic Therapy ◽  
Early Ra ◽  
Lv Diastolic Function

Background:Objectives:to evaluate the effect of antirheumatic therapy according to the “treat to target” strategy on the course of chronic heart failure (CHF) in patients with early RA.Methods:The study included 22 patients CHF with valid diagnosis of RA (criteria ACR / EULAR, 2010), 17 (77%) of women, median (Me) age - 60 years, Me disease duration - 7 months; IgM seropositive for rheumatoid factor 10 (45%) and / or antibodies to the cyclic citrulline peptide 22 (100%), DAS28-5.6 [4,8;6,5]. CHF verified in accordance the recommendations for the diagnosis and treatment of CHF Society of Specialists in Heart Failure (2013). The concentration of NT-proBNP was determined by electrochemiluminescence. For all patients was started methotrexate (MT) therapy with a rapid increase in the dose to 30 mg per week subcutaneously. If the MT was not effective enough, after 3 months a biological Disease-Modifying Anti-Rheumatic Drug (bDMARDs) was added to the therapy, predominantly TNF-alpha inhibitors. After 18 months, 10 (45%) patients were in remission and low disease activity, 6 (60%) of patients underwent MT therapy in combination with bDMARDs.Results:In baseline CHF with preserved EF was revealed in 21 (95%) patients, in 1 patient - CHF with reduced EF. After 18 months there was a positive dynamics of improvement of clinical symptoms, echocardiographic indicators (decrease the size of the left atrium (LА) and the index of end-systolic volume of LА, IVRT, E’ LV), diastolic function of the left ventricle (LV). There was no decompensation of CHF. LV diastolic function normalized in 7 (32%) patients who reached the target level of blood pressure, remission (n = 5) and low (n = 2) disease activity, mainly in the treatment of MT and bDMARDs. In patients with RA and CHF, the level of NT-proBNP decreased from 192.2 [151.4; 266.4] to 114.0 [90.4; 163.4] pg / ml (p <0.001), normalized in 16 of 22 (73%) patients (p <0.001) with remission or low RA activity. In 5 (22%) patients, the clinical manifestations of CHF regressed, LV diastolic function and NT-proBNP level normalized.Conclusion:In patients with early RA and CHF anti-rheumatic therapy improves the clinical course of CHF. There were an improvement in the clinical course of CHF, diastolic function of the left ventricle and a decrease in NT-proBNP.Disclosure of Interests:None declared

Surgical methods of treatment of chronic heart failure and their place in modern clinical recommendations

2020 ◽  
Vol 22 (4) ◽  
pp. 183-191
Author(s):  
O. T. Kotsoeva ◽  
A. V. Koltsov ◽  
V. V. Tyrenko ◽  
A. A. Ialovets
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Left Ventricle ◽  
Heart Transplantation ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Surgical Methods ◽  
The Moment

This review discusses a number of aspects of surgical methods for treating severe chronic heart failure: resynchronizing therapy, mechanical circulatory support systems, and heart transplantation. Surgical methods for the treatment of heart failure are a rapidly developing field of modern cardiology and cardiac surgery. The main surgical method of treatment was and remains orthotopic transplantation of a donor heart. The advent of implantable systems has affected the problem of heart transplantation. Over the past decade, the use of mechanical circulatory support systems has grown significantly. At the moment, there are 3 main directions: creating devices for auxiliary blood circulation, various modes and methods of electrical stimulation of the myocardium, creating devices that mechanically remodel the heart chambers (left ventricle). All of these directions to some extent (depending on the evidence base) have found their place in modern recommendations for the treatment of chronic heart failure. The use of mechanical left ventricular remodeling shows good results in patients suffering from symptomatic heart failure, which leads to a significant and persistent decrease in the volume of the left ventricle and improvement of its function, symptoms and quality of life. Despite the fact that at the moment the geography and prevalence of their use is small, the number of implanted devices will only grow. Thus, given the need for frequent hospitalizations and high treatment costs, it is necessary to improve modern methods of surgical treatment of severe and terminal heart failure, make them more accessible, which will affect the duration and quality of life of these patients.

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