scholarly journals Acute decompensation of chronic heart failure and renal dysfunction. Diagnosis and treatment

2020 ◽  
Vol 35 (2) ◽  
pp. 35-43
Author(s):  
S. L. Glizer ◽  
O. A. Shtegman ◽  
M. M. Petrova
Keyword(s):  
Heart Failure ◽  
Renal Failure ◽  
Chronic Heart Failure ◽  
Kidney Function ◽  
21St Century ◽  
Social Problem ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Common Cause ◽  
Acute Decompensation

Chronic heart failure (CHF) is an essential medical, economic, and social problem of the 21st century. Acute decompensated heart failure (ADHF) is a common cause of hospitalization and mortality in patients with CHF. The article presents the analysis of frequency, prognostic signifi cance, and features of renal failure onset in ADHF patients, as well as the effects of various groups of drugs used in the treatment of ADHF on the kidney function. Special aspects of administering these drugs are elucidated in the context of deteriorating kidney function.

scholarly journals Acute decompensated heart failure: a study of nursing care

2020 ◽  
Vol 15 (3) ◽  
pp. 1-12
Author(s):  
Nicholas Woolfe Loftus ◽  
Tracey Bowden
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Pulmonary Oedema ◽  
Acute Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Clinical Signs ◽  
Decompensated Heart Failure ◽  
Medical Attention ◽  
Acute Decompensation ◽  
Care Study

This care study focuses on the initial acute phase of care for a patient with acutely decompensated heart failure. Heart failure is a syndrome characterised by clinical signs, such as pulmonary oedema, and symptoms, such as dyspnoea. Acute heart failure develops rapidly and requires urgent medical attention, unlike the slower insidious onset of chronic heart failure. Acute heart failure can be either new or acute decompensation of chronic heart failure. The patient presented with cardiogenic pulmonary oedema because of acute decompensation of his chronic heart failure. He agreed to medical management, which included continuous positive airway pressure, intra-arterial cannulation and a furosemide infusion. This treatment proved largely effective, but it may have been better if his furosemide infusion had been stopped sooner. The implications for practice are explored in this care study.

scholarly journals Evolution of B-type natriuretic peptide and N-terminal pro-brain natriuretic peptide during acute decompensated heart failure in a chronic heart failure patient with reduced ejection fraction treated with Sacubitril/Valsartan: a case report

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Ambre Tiepolo ◽  
Hélène Nougué ◽  
Charles Damoisel ◽  
Jean-Marie Launay ◽  
Nicolas Vodovar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Natriuretic Peptide ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Chronic Heart Failure Patient ◽  
Reduced Ejection Fraction ◽  
Case Summary ◽  
Acute Decompensation

Abstract Background B-type natriuretic peptide (BNP) and the N-terminal proBNP (NT-proBNP) exhibit different evolution in chronic heart failure patients with reduced ejection fraction treated with Sacubitril/Valsartan; BNP increasing or remaining stable, while NT-proBNP decreases. However, how this difference translates upon acute decompensation is unknown. Case summary Herein, we described in a 78-year-old woman with chronic heart failure with reduced ejection fraction treated with Sacubitril/Valsartan who had acute decompensated heart failure (ADHF). BNP and NT-proBNP were markedly high during ADHF and showed parallel return to baseline level after clinical improvement. Discussion BNP and NT-proBNP retained similar value for the diagnosis of ADHF in patient treated with Sacubitril/Valsartan. These findings strongly suggest that either BNP or NT-proBNP can be used indifferently in this context, while their relative use is debated in chronic heart failure.

scholarly journals Etiology and Prognosis of Cardiogenic Shock in a Secondary Center without Surgical Back-Up

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Laurent Bonello ◽  
Marc Laine ◽  
Etienne Puymirat ◽  
Victoria Ceccaldi ◽  
Mélanie Gaubert ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Rank Test ◽  
First Episode ◽  
Common Cause ◽  
Secondary Center ◽  
Acute Decompensation

Background. Cardiogenic shock (CS) remains a major challenge in contemporary cardiology. Data regarding CS etiologies and their prognosis are limited and mainly derived from tertiary referral centers. Aims. To investigate the current etiologies of cardiogenic shock and their associated short- and long-term outcomes in a secondary center without surgical back-up. Methods. We performed an observational prospective monocenter study. All patients admitted for a first episode of CS related to left ventricular dysfunction were enrolled. The definition of CS was consistent with the European Society of Cardiology guidelines. Patients were followed for 6 months. Etiologies were analyzed, and survival rates derived from Kaplan-Meier estimates were compared with the log-rank test. Results. Between January 2015 and January 2016, 152 patients were included. The first most common cause of CS was acute decompensation of chronic heart failure (CHF). Acute coronary syndromes (ACS) were the second most common cause of CS (35.4%). At one month, the all-cause mortality rate was 39.5% and was similar between ACS and CHF (43% vs 35%, respectively; p=0.7). In a landmark analysis between 1 and 6 months, we observed a significantly higher mortality in patients with CHF than in patients with ACS (18% vs. 0%; p=0.01). Conclusions. In the present registry, acute decompensation of chronic heart failure was the most common cause of CS, while ACS complicated by CS was the second most common cause. Of importance, acute decompensation of CHF was associated with a significantly worse outcome than ACS in the long term.

P15 Serum chloride as marker for prognosis for patient with acute decompensated heart failure: a systematic review and meta-analysis on prognosis

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
L K Evangelista ◽  
J D Ramos ◽  
D L Villanueva ◽  
M D Tiongson ◽  
F E Punzalan
Keyword(s):  
Heart Failure ◽  
Cohort Studies ◽  
Quality Assessment ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Cochrane Central Register ◽  
Serum Chloride ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Acute Decompensation

Abstract Background  Several studies have suggested that hypochloremia is associated with adverse outcomes among patients with heart failure. The association appears to be more marked in those with acute decompensation. Research Question: What is the association of hypochloremia with mortality and worsening heart failure among patients in acute decompensation? Objective Determine the association of admission hypochloremia to all-cause mortality, heart failure death and worsening heart failure among patients with acute decompensated heart failure. Criteria for Inclusion of Studies: Studies were included if they satisfied the following criteria 1) observational cohort studies; 2) included patients admitted for acute decompensated heart failure; and 3) reported data on mortality and worsening heart failure in association with admission hypochloremia. Methods A systematic search using MEDLINE, Clinical Key, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials databases was done, from June 2018 to January 31, 2019. The characteristics of included studies were collated. Data abstraction and quality assessment, using the Newcastle-Ottawa Quality Assessment Scale, were done independently by two reviewers, and disagreements were settled by a third reviewer. Review Manager (RevMan) 5.3 was utilized to perform Mantel-Haenzel analysis of random effects and compute for relative risk. Results We included three high quality cohort studies involving 3,444 patients admitted for acute decompensated heart failure and having low serum chloride levels on admission. Our study shows that admission hypochloremia is associated with increased risk for all-cause mortality [RR 1.63, (95% CI 1.60 to 2.28, p < 0.00001]. Risks for heart failure death as mentioned in one study and worsening heart failure also in one study are likewise increased with hypochloremia on admission.  Conclusion Admission hypochloremia is associated with higher all-cause mortality among patients admitted for acute decompensated heart failure. The risk for heart failure death and worsening heart failure are also increased. Admission hypochloremia may be a useful prognosticator for heart failure patients.

Heart Failure

2020 ◽  
Author(s):  
Sachin P Shah ◽  
Mandeep R. Mehra
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Heart Association ◽  
Decompensated Heart Failure ◽  
Advanced Heart Failure ◽  
Circulatory Support ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction

Heart failure is a syndrome related to abnormal cardiac performance with a consequence of impaired cardiac output at rest or with exertion and/or congestion, which usually leads to symptoms of fatigue, dyspnea, and edema. The syndrome is characterized by various phenotypes related to a vast array of etiologies with diverse management targets. The current broad categorization of heart failure separates patients based on ejection fraction. Further description of the phenotype beyond ejection fraction is imperative to correctly identify the etiology of heart failure and, ultimately, to choose medical, device, and surgical therapies appropriately. This review covers the epidemiology of heart failure, defining the phenotype and etiology of heart failure, recognition and management of acute decompensated heart failure, management of chronic heart failure with a reduced ejection fraction, implantable cardioverter-defibrillators in heart failure with a reduced ejection fraction, management of heart failure with a preserved ejection fraction, and advanced heart failure. Figures show the evolution of therapy in chronic heart failure from the symptom-directed model, the complex pathophysiology and principal aberrations underlying heart failure with preserved ejection fraction, and concepts underlying surgical therapy in advanced heart failure using Laplace’s law. Tables list various etiologies of heart failure; sensitivity and specificity of clinical, biomarker, and radiographic data in the diagnosis of acute decompensated heart failure; drugs and devices with a demonstrated survival benefit in heart failure with a reduced ejection fraction; neurohormonal antagonist dosing in heart failure with a reduced ejection fraction; randomized, placebo-controlled trials in heart failure with a preserved ejection fraction; categorization of heart failure according to American Heart Association/American College of Cardiology heart failure stage, New York Heart Association functional class, and Interagency Registry for Mechanically Assisted Circulatory Support level; and poor prognostic indicators in heart failure. This review contains 4 highly rendered figures, 8 tables, and 114 references.

Heart Failure

2018 ◽  
Author(s):  
Sachin P Shah ◽  
Mandeep R. Mehra
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Heart Association ◽  
Decompensated Heart Failure ◽  
Advanced Heart Failure ◽  
Circulatory Support ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction

Heart failure is a syndrome related to abnormal cardiac performance with a consequence of impaired cardiac output at rest or with exertion and/or congestion, which usually leads to symptoms of fatigue, dyspnea, and edema. The syndrome is characterized by various phenotypes related to a vast array of etiologies with diverse management targets. The current broad categorization of heart failure separates patients based on ejection fraction. Further description of the phenotype beyond ejection fraction is imperative to correctly identify the etiology of heart failure and, ultimately, to choose medical, device, and surgical therapies appropriately. This review covers the epidemiology of heart failure, defining the phenotype and etiology of heart failure, recognition and management of acute decompensated heart failure, management of chronic heart failure with a reduced ejection fraction, implantable cardioverter-defibrillators in heart failure with a reduced ejection fraction, management of heart failure with a preserved ejection fraction, and advanced heart failure. Figures show the evolution of therapy in chronic heart failure from the symptom-directed model, the complex pathophysiology and principal aberrations underlying heart failure with preserved ejection fraction, and concepts underlying surgical therapy in advanced heart failure using Laplace’s law. Tables list various etiologies of heart failure; sensitivity and specificity of clinical, biomarker, and radiographic data in the diagnosis of acute decompensated heart failure; drugs and devices with a demonstrated survival benefit in heart failure with a reduced ejection fraction; neurohormonal antagonist dosing in heart failure with a reduced ejection fraction; randomized, placebo-controlled trials in heart failure with a preserved ejection fraction; categorization of heart failure according to American Heart Association/American College of Cardiology heart failure stage, New York Heart Association functional class, and Interagency Registry for Mechanically Assisted Circulatory Support level; and poor prognostic indicators in heart failure. This review contains 3 highly rendered figures, 7 tables, and 113 references.

scholarly journals Intra-cardiac microcomputer allows for innovative telemedicine in chronic heart failure during coronavirus disease-2019 pandemic: a case report

2020 ◽  
Author(s):  
Sebastian Feickert ◽  
Giuseppe D’Ancona ◽  
Monica Murero ◽  
Hüseyin Ince
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Chronic Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Disease Spread ◽  
Case Summary ◽  
Infective Disease ◽  
Risk Patients

Abstract Background  Heart failure patient management guided by invasive intra-cardiac and pulmonary pressure measurements through permanent intra-cardiac micro-sensors has recently been published as a strategy to individualize the therapy of patients with chronic heart failure to reduce re-hospitalization and optimize quality of life. Furthermore, the use of telemedicine could have an important impact on infective disease spread during the current coronavirus disease-2019 pandemic. Case summary  Emergent hospitalization of a patient with acute on chronic heart failure, who is currently in self-isolation as a result of his comorbid profile that exposes him to high risk for severe course and mortality in case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was prevented using a last generation telemedicine tool. Discussion  Further implementation of invasive telemedicine could prevent hospitalization for acute decompensated heart failure and consecutive exposure to a potential hospital infection with SARS-CoV-2 in high-risk patients.

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