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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute heart failure (AHF) is a serious clinical condition associated with high morbidity and mortality. The authors present the case of a 61-year-old man, with a past history of idiopathic dilated cardiomyopathy with heart failure, who came to the emergency room due to acute decompensation. During hospital stay he developed cardiogenic shock and inotropic support was initiated, followed by mechanical circulatory assistance with intra-aortic balloon counterpulsation, as a bridge to heart transplantation. The authors discuss theoretical considerations concerning subtypes and etiology of AHF, and indications for the use of mechanical support and heart transplantation.
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PMID:Acute heart failure--intra-aortic balloon: a forgotten treatment. 1855 22

Acute heart failure syndromes (AHFS), with a high post-discharge mortality and rehospitalization rate, represent a significant public health burden. The treatment of patients hospitalized with AHFS often includes the use of vasoactive medications such as inotropes and vasodilators. Although such agents are frequently used, their safety and efficacy remain controversial. A significant number of patients with heart failure have underlying coronary artery disease and may be at greater risk from hemodynamic alterations that can diminish coronary perfusion. In AHFS, the relationship among vasoactive medications, coronary perfusion, and potential myocardial injury needs further investigation. Newer techniques now available to evaluate coronary perfusion should provide guidance for the evaluation of existing and future vasoactive therapies for AHFS.
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PMID:Acute heart failure syndromes and coronary perfusion. 1858 29

Acute heart failure is associated with dyspnea that is usually defined as difficulty in breathing that is accompanied by an element of distress. It is commonly associated with an increase in the rate of ventilation, wheezing, an increase in airway secretions and cough. This review examines the reflexes which generate these responses with particular reference to the role of rapidly adapting receptors (RAR) in the airways. The essential feature of acute heart failure is an increase in pulmonary extravascular fluid volume. Small acute increases in extravascular fluid volume in the airways activate the RAR. With larger increases both the RAR and the C-fiber receptors in the airways and the alveoli are activated. Activation of RAR causes a reflex increase in respiratory rate, tracheal tone and mucus secretion from the airways. It is suggested that the RAR play a significant role in monitoring changes in the extravascular fluid volume of the airways and mediate the respiratory reflexes associated with acute heart failure.
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PMID:Rapidly adapting receptors in acute heart failure and their impact on dyspnea. 1897 61

Acute heart failure syndromes are a common cause of emergency department visits and hospitalization in North America and Europe. Although in-hospital mortality is relatively low, the postdischarge mortality and rehospitalization rates can be as high as 10-15 and 30%, respectively, within 60-90 days following discharge. It appears that the main reason for admission and readmission for heart failure is related to congestion manifested by dyspnea, jugular venous distension and edema. Often, congestion is associated with dilutional hyponatremia that is difficult to treat. Hyponatremia is an important predictor of increased mortality and the available therapies to treat congestion and/or hyponatremia are often ineffective and/or unsafe. Accordingly, there is an unmet need to develop a new agent that effectively relieves congestion due to high filling pressure without worsening renal function and improving or normalizing serum sodium in hyponatremic patients. This paper provides an overview of a new compound, tolvaptan, an oral selective V(2)-vasopressin antagonist in light of the recently published Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial. The biochemical and pharmacological properties are discussed in conjunction with its clinical efficacy and safety, exploring the potential role of tolvaptan in the management of acute heart failure syndromes presenting with or without hyponatremia.
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PMID:EVEREST study: Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan. 1901 85

One million patients are hospitalized each year with acute decompensated heart failure, and up to 20% of these patients are rehospitalized within a month after the acute presentation. Acute heart failure (AHF) accounts for 50,000 deaths annually and is the most frequent reason for hospital admissions in the United States. This article reviews the therapeutic options and the results of recent clinical trials in the treatment of AHF. Most patients can be effectively managed by use of diuretic agents or diuretics in combinations with nitrates, IV nitroglycerin, IV nitroprusside, and possibly IV nesiritide. Ultrafiltration is a promising technique that can be very helpful in the resistant patient. However, given the ease of initiation of diuretic therapy, it is unlikely that ultrafiltration would supplant diuretic use in acutely symptomatic patients. Patients in acute distress with AHF almost invariably respond to diuretics or a vasodilator combined with diuretic therapy. The loop diuretics are the most effective diuretics and thus most frequently used agents in treating AHF. Currently, there are 4 loop diuretics in the US market: furosemide, bumetanide, torsemide, and ethacrynic acid. IV furosemide and ethacrynic acid have a prompt venous dilatory effect, consequently decrease left ventricular filling pressure and immediately relieve symptoms of pulmonary congestion, before a diuresis can occur. Furosemide is more often used than ethacrynic acid due to its reduced ototoxic potential. However, ethacrynic acid should be used in sulfa-sensitive patients because ethacrynic acid is the only loop diuretic, which does not contain a sulfa moiety.
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PMID:The management of acute heart failure and diuretic therapy. 1914 55

Acute heart failure syndromes (AHFS) have emerged as a leading public health problem worldwide, accounting for a substantial number of hospitalizations and a high utilization of resources. Although in-hospital mortality rates are relatively low, patients with AHFS have very high early after-discharge mortality and rehospitalization rates. The majority of patients admitted with AHFS have coronary artery disease (CAD), which independently has an adverse impact on prognosis. The initial in-hospital and after-discharge management of AHFS may be dependent on clinical presentation: AHFS in patients with underlying CAD or acute coronary syndromes (ACS) complicated by heart failure. In addition, the extent and severity of CAD and the presence of ischemia and/or stunned/hibernating myocardium should be assessed for optimal management. Although the overall management of AHFS with CAD may be similar to that in patients with ACS complicated by heart failure, for which specific guidelines exist, management of the former is less well defined. Prospective studies of the assessment and treatment of CAD in patients with AHFS are urgently needed.
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PMID:Acute heart failure syndromes in patients with coronary artery disease early assessment and treatment. 1914 42

Acute heart failure is a common clinical problem faced in cardiac surgery operating rooms and intensive care units. Levosimendan, an inotropic and vasodilating agent used widely in cases of acute heart failure for "cardiological" patients, has not gained global acceptance in its application for heart-operated ones. Herein, we are presenting a series of studies and patents concerning this medication, which, in general, support the use of levosimendan during and after heart surgery, despite the relatively high cost of administration. However, trials with larger samples of patients have to be performed in order to definitively establish this medication as a routinely administered drug for acute congestive heart failure after heart surgery.
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PMID:Levosimendan for heart-operated patients: what is the state of the art? 1914 2

Acute heart failure syndromes (AHFS) are characterized by a gradual or rapid progression of the signs and symptoms of heart failure (HF), resulting in a need for urgent therapy. Patients with AHFS comprise approximately 20% of all HF patients and represent the most severely ill and undermanaged subpopulation of patients with HF. Despite the rising prevalence and costs associated with AHFS, the disease remains largely undermanaged, partially as a result of a failure to initiate treatment with proven therapies, such as beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers, during hospitalization or soon after discharge. Although professional organizations have been striving to improve the state of care for AHFS by providing at least some level of consensus and evidence-based treatment recommendations, the gap between the clinical evidence and actual practice is growing. Appropriate disease assessment, followed by the implementation of life-saving therapies, is the key to improving outcomes. Managed care initiatives, such as improved quality measures, disease management programs, patient education efforts, hospital discharge checklists, and pharmacy-led interventions to enhance medication compliance, provide potential solutions for combating the alarming rise of morbidity, mortality, and costs associated with this disease.
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PMID:Managed care interventions for improving outcomes in acute heart failure syndromes. 1916 73

Acute heart failure syndromes (AHFS) are associated with the rapid onset of heart failure (HF) signs and symptoms. Hospitalizations for AHFS continue to rise and are associated with significant mortality and morbidity. Several pharmacological agents are currently approved for the treatment of AHFS, but their use is associated with an increase in short-term mortality. There is a need for new agents that can be given in the acute setting with increased efficacy and safety. Istaroxime is a unique agent with both inotropic and lusitropic properties which is currently being studied for the treatment of AHFS. Istaroxime inhibits the sodium-potassium adenosine triphosphatase (ATPase) and stimulates the sarcoplasmic reticulum calcium ATPase isoform 2 (SERCA-2) thereby improving contractility and diastolic relaxation. Early data from human studies reveal that istaroxime decreases pulmonary capillary wedge pressure (PCWP) and possibly improves diastolic function without causing a significant change in heart rate (HR), blood pressure, ischemic or arrhythmic events. Most commonly reported side effects were related to gastrointestinal intolerance and were dose related. In conclusion, istaroxime is a novel agent being investigated for the treatment of AHFS whose mechanism of action and cellular targets make it a promising therapy. Further studies with longer infusion times in patients with hypotension are required to confirm its efficacy and safety.
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PMID:Istaroxime, a first in class new chemical entity exhibiting SERCA-2 activation and Na-K-ATPase inhibition: a new promising treatment for acute heart failure syndromes? 1923 40

A case of acute heart failure due to Takotsubo cardiomyopathy induced by 5-fluorouracil is described. Acute heart failure developed during the administration of 5-fluorouracil (5-FU) and levofolinate calcium in a 62-year-old woman who had underwent a Miles operation for rectal adenocarcinoma. Electrocardiography upon admission showed slight ST elevation in leads V1-3, and follow-up electrocardiography on the third hospital day evealed QT interval prolongation and giant negative T waves in leads II, III, aVF, and V1-6. Echocardiography and myocardial scintigraphy showed left ventricular apical ballooning in the acute phase of heart failure, but left ventricular contraction was normal during the recovery phase. Coronary angiography demonstrated normal coronary arteries, and multi-vessel coronary artery vasospasms including microcirculation disorders could be provoked by intracoronary acetylcholine infusion during, but not before, the intravenous administration of levofolinate calcium and 5-FU. The cause of heart failure in this patient, Takotsubo cardiomyopathy induced by multivessel coronary vasospasm including microcirculation disorders only during 5-FU administration, is notable.
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PMID:A case of Takotsubo cardiomyopathy during 5-fluorouracil treatment for rectal adenocarcinoma. 1930 8


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