scholarly journals β1-Blockers Enhance Inotropy of Endogenous Catecholamines in Chronic Heart Failure

2021 ◽  
Vol 8 ◽  
Author(s):  
Thomas J. Feuerstein ◽  
Eberhard Schlicker
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Binomial Distribution ◽  
Dissociation Constants ◽  
Acute Decompensated Heart Failure ◽  
Negative Inotropic Effect ◽  
Decompensated Heart Failure ◽  
Inotropic Effect ◽  
Inotropic Effects ◽  
Endogenous Catecholamines

Although β1-blockers impressively reduce mortality in chronic heart failure (CHF), there are concerns about negative inotropic effects and worsening of hemodynamics in acute decompensated heart failure. May receptor theory dispel these concerns and confirm clinical practice to use β1-blockers? In CHF, concentrations of catecholamines at the β1-adrenoceptors usually exceed their dissociation constants (KDs). The homodimeric β1-adrenoceptors have a receptor reserve and display negative cooperativity. We considered the binomial distribution of occupied receptor dimers with respect to the interaction of an exogenous β1-blocker and elevated endogenous agonist concentrations > [KDs], corresponding to an elevated sympathetic tone. Modeling based on binomial distribution suggests that despite the presence of a low concentration of the antagonist, the activation of the dimer receptors is higher than that in its absence. Obviously, the antagonist improves the ratio of the dimer receptors with only single agonist activation compared with the dimer receptors with double activation. This leads to increased positive inotropic effects of endogenous catecholamines due to a β1-blocker. To understand the positive inotropic sequels of β1-blockers in CHF is clinically relevant. This article may help to eliminate the skepticism of clinicians about the use of β1-blockers because of their supposed negative inotropic effect, since, on the contrary, a positive inotropic effect can be expected for receptor-theoretical reasons.

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.

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.

scholarly journals Heart Rate at Discharge in Patients with Acute Decompensated Heart Failure is a Predictor of Mortality

2020 ◽  
Author(s):  
Thomas Vollmert ◽  
Martin Hellmich ◽  
Natig Gassanov ◽  
Fikret Er ◽  
Seyrani Yücel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Chronic Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Survival Rates ◽  
Treatment Strategies ◽  
Decompensated Heart Failure ◽  
University Hospital ◽  
Heart Failure Patients ◽  
Prediction Of Mortality

Abstract Aims Heart failure is a syndrome with increasing prevalence in concordance with the aging population and better survival rates from myocardial infarction. Morbidity and mortality are high in chronic heart failure patients, particularly in those with hospital admission for acute decompensation. Several risk stratification tools and score systems have been established to predict mortality in chronic heart failure patients. However, identification of patients at risk with easy obtainable clinical factors that can predict mortality in acute decompensated heart failure (ADHF) are needed to optimize the care-path. Methods and Results We retrospectively analyzed electronic medical records of 78 patients with HFrEF and HFmrEF who were hospitalized with ADHF in the Heart Center of the University Hospital Cologne in the year 2011 and discharged from the ward after successful treatment. 37.6±16.4 months after index hospitalization 30 (38,5%) patients had died. This mortality rate correlated well with the calculated predicted survival with the Seattle Heart Failure Model (SHFM) for each individual patient. In our cohort, we identified elevated heart rate at discharge as an independent predictor for mortality (p=0.016). The mean heart rate at discharge was lower in survived patients compared to patients who died (72.5±11.9 bpm vs. 79.1±11.2 bpm. Heart rate of 77 bpm or higher was associated with an almost doubled mortality risk (p=0.015). Heart rate elevation of 5 bpm was associated with an increase of mortality of 25% (p=0.022).Conclusions Patients hospitalized for ADHF seem to have a better prognosis, when heart rate at discharge is <77 bpm. Heart rate at discharge is an easily obtainable biomarker for risk prediction of mortality in HFrEF and HFmrEF patients treated for acute cardiac decompensation. Taking into account this parameter could be useful for guiding treatment strategies in these high-risk patients. Prospective data for validation of this biomarker and specific intervention is needed.

scholarly journals Biomarkers and the prediction of adverse outcomes in patients with acute decompensated heart failure and kidney injury

2021 ◽  
Vol 10 (3) ◽  
pp. 65-71
Author(s):  
S. L. Glizer ◽  
O. A. Shtegman ◽  
M. M. Petrova
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Chronic Heart Failure ◽  
Adverse Outcome ◽  
Acute Decompensated Heart Failure ◽  
Kidney Injury ◽  
Decompensated Heart Failure ◽  
Adverse Outcomes ◽  
Global Burden ◽  
Modern Treatment

Abstract. Chronic heart failure is one of the main contributors to the Global Burden of Cardiovascular Diseases. Despite advances in modern treatment, acute decompensated heart failure (ADHF) incidence is high. Moreover, patients admitted for ADHF encounter renal impairment, which is another predictor of adverse outcome. There are number of biomarkers that allow clinicians to assess the prognosis of the disease in the early stages. The article presents an overview of contemporary biomarkers (utilizing multimarker approach), and identifies the most significant biological markers for evaluating ADHF and worsening renal function.

scholarly journals Medical management of decompensated heart failure in adult patients: Part 1: Definition and medical management

2020 ◽  
Vol 8 (36) ◽  
pp. 1-9
Author(s):  
Mohamed Elmassry ◽  
Rubayat Rahman ◽  
Pablo Paz ◽  
Barbara Mantilla ◽  
Scott Shurmur ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Medical Management ◽  
Acute Decompensated Heart Failure ◽  
Heart Association ◽  
Decompensated Heart Failure ◽  
Fluid Restriction ◽  
Mortality And Morbidity ◽  
Randomized Controlled Clinical Trials ◽  
Definition Of

Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients older than 65 years. It continues to increase in prevalence and is associated with significant mortality and morbidity including frequent hospitalizations. The American Heart Association is predicting that more than 8 million Americans will have heart failure by 2030 and that the total direct costs associated with the disease will rise from $21 billion in 2012 to $70 billion in 2030. The definition of ADHF has important limitations, and its management differs significantly from that of chronic heart failure. Although many large, randomized, controlled clinical trials have been conducted in patients with chronic heart failure, it was not until recently that more studies began to address the management of ADHF. The mainstay of ADHF management involves identification of precipitating factors, oxygen supplementation, sodium and fluid restriction, and diuresis. The phenomenon of diuretic resistance is a significant obstacle to relief of congestion and is a field of active investigation. Other important adjuncts to treatment include noninvasive ventilation, inotropes, vasopressors, nitrates, opiates, and vasopressin receptor antagonists. In this review, we will discuss the terminology and classification of ADHF, and review the multiple modalities and strategies available for the management of this disorder. Keywords: heart failure, medical management, complications, devices, palliative care

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.

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.

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