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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 in previously healthy young patients is a diagnostic challenge. We describe a case of severe acute heart failure in a 38 year-old patient complicated by acute renal failure and incidental abdominal mass.
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PMID:Severe unexplained heart failure in a young person. 2117 94

Acute heart failure syndromes (AHFS) represent the most common discharge diagnoses in adults over age 65 and translate into dramatically increased heart failure-associated morbidity and mortality. Conventional approaches to the early detection of pulmonary and systemic congestion have been shown to be of limited sensitivity. Despite their proven efficacy, disease management and structured telephone support programs have failed to achieve widespread use in part due to their resource intensiveness and reliance upon motivated patients. While once thought to hold great promise, results from recent prospective studies on telemonitoring strategies have proven disappointing. Implantable devices with their capacity to monitor electrophysiologic and hemodynamic parameters over long periods of time and with minimal reliance on patient participation may provide solutions to some of these problems. Conventional electrophysiologic parameters and intrathoracic impedance data are currently available in the growing population of heart failure patients with equipped devices. A variety of implantable hemodynamic monitors are currently under investigation. How best to integrate these devices into a systematic approach to the management of patients before, during, and after AHFS is yet to be established.
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PMID:Device monitoring strategies in acute heart failure syndromes. 2142 78

Acute heart failure is an important presentation in the Acute Medical Unit. We describe a case of successful repeat thrombolysis in an elderly woman presenting as an emergency with severe pulmonary oedema, due to acute prosthetic mitral valve thrombosis. The diagnostic imaging and therapeutic modalities available are also described.This case highlights the need for acute physicians to consider prosthetic valve thrombosis in the differential for patients with metallic heart valves who present with acute heart failure or cardiogenic shock.
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PMID:A successful case of repeat thrombolysis in acute prosthetic valve thrombosis. 2159 76

Acute heart failure (AHF) affects nearly every Canadian with heart failure (HF) at least once. Despite several attempts, no medical therapies have been shown to improve the natural history of AHF. In addition, the place of diagnosis of AHF is increasingly made in the outpatient setting. In this view, AHF is a moving target, and from recent registry data and from clinical trials, 5 critical lessons regarding the syndrome of AHF emerge: (1) The period of clinical instability preceding AHF may be much longer than previously thought. (2) Refinement of tools used to aid the early and accurate diagnosis of AHF will impact patient outcomes. (3) Standard supportive care of patients with AHF includes early use of diuretics with frequent reassessment in nearly all patients and supplemental vasodilators and oxygen therapy in selected cases. (4) Patients who survive presentation of AHF continue to suffer high rates of re-presentation, death, and rehospitalization following discharge from either hospital or emergency department. (5) Interventions shown to improve patient outcomes for AHF to date are related to process of care rather than new medications or devices. This report reviews the recent literature regarding the presentation, diagnosis, management, and prognosis of AHF. Areas of future research priority are indicated and guidelines for improving treatment are provided. AHF is an important clinical area that has not been as intensively studied as chronic HF; it presents both important needs and exciting opportunities for research and innovation.
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PMID:Acute heart failure: lessons learned so far. 2160 68

Acute heart failure syndromes (AHFS) are a heterogeneous group of commonly encountered and difficult to manage clinical syndromes associated with high morbidity and mortality. Dyspnoea, pulmonary, and systemic congestion often characterize AHFS due to acutely elevated intracardiac filling pressures and fluid overload. Diuresis, respiratory support, vasodilator therapy, and gradual attenuation of the activation of renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS) are the keystones of AHFS management. Despite available therapies, post-discharge mortality and re-hospitalization rates remain unacceptably high in AHFS. Neurohumoral-mediated cardiorenal dysfunction and congestion may contribute to these high event rates. Mineralocorticoid receptor antagonists (MRAs) serve a dual therapeutic role by enhancing diuresis and attenuating the pathological effects of RAAS and SNS activation. Although these agents are indicated in patients with chronic, severe heart failure with reduced ejection fraction (HF/REF) and in patients with HF/REF post-myocardial infarction (MI), they have not been systematically studied in patients with AHFS. The purpose of this review is to explore the potential efficacy and safety of MRAs in AHFS.
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PMID:Mineralocorticoid receptor antagonism: therapeutic potential in acute heart failure syndromes. 2167 33

Acute heart failure is one of the most common condition leading to hospital admission and is burdened by important mortality and readmission rates. A timely diagnosis of congestive heart failure at admission by hospitalists is essential for an early and tailored medical management. The initial clinical evaluation based on symptoms, physical signs and chest radiography remains inconclusive for the diagnosis in many patients with acute dyspnea, and the use of natriuretic peptide testing (BNP and NT-proBNP) through a two cut-point strategy is currently recommended as first-line diagnostic complement in the acute care setting. Bedside Doppler echocardiography is another reliable, noninvasive method that offers additional diagnostic information over the initial clinical evaluation. Along with echocardiographic evidence of depressed left ventricular systolic function, several simple Doppler indexes have been validated in the emergency diagnosis of congestive heart failure. Doppler echocardiography at bedside may especially benefit to patients with intermediate, inconclusive natriuretic peptide concentrations. The aim of the present review was to offer to the hospitalist a practical overview on the relative contribution of natriuretic peptide testing and bedside Doppler echocardiography to the diagnosis of acute heart failure in the emergency care setting.
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PMID:Contribution of natriuretic peptide testing and Doppler echocardiography at bedside to the diagnosis of acute heart failure. A practical overview. 2285 16

In Western countries, the incidence of acute heart failure has been growing rapidly and is associated with increased incidence of mortality. Acute heart failure encompasses an extended spectrum of clinical presentation. From these, cardiogenic shock remains its most dramatic entity and is burdened by a dismal prognosis. As the initial therapeutic armamentarium (pressor agents, non-invasive or invasive ventilation using positive end-expiratory pressure, treatment of the damaging agent, ultrafiltration and intra-aortic balloon counterpulsation) might be soon overcome, implantation of mechanical ventricular assistance should be considered. Constant technical improvements have allowed quick and percutaneous implantation of such left ventricular assistance devices (LVADs). Herein, we review the technical characteristics and clinical data of the percutaneous LVADs currently available in Europe for treatment of overt cardiogenic shock.
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PMID:Ventricular assist devices in acute heart failure. 2285 17

Acute heart failure is a public health issue with morbidity and mortality exceeding that of myocardial infarction. Novel compounds for the treatment of acute heart failure are clearly needed and fall into the general categories of inotropic, vasodilatory and other compounds in phase I to III of development. Furthest along are omecamtiv mecarbil (a cardiac myosin activator), ularitide (a natriuretic and diuretic peptide) and relaxin (a vasodilator). Each compound has a unique set of assets and liabilities that will aid in the understanding of the syndrome and application to the right patients at the right time in this heterogeneous syndrome. This review will explore current and future novel pharmacologic therapies for the treatment of acute heart failure.
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PMID:Novel pharmacologic therapies in development for acute decompensated heart failure. 2331 27

Acute heart failure is a common and potentially life threatening presentation to hospitals in the U.K.. Acute physicians at the front door of the hospital will often be involved with the initial management of these patients. Despite its many underlying causes, certain general treatment principles exist. We present a typical clinical scenario followed by an overview of the pathophysiology and management of acute heart failure and cardiogenic pulmonary oedema. The aim is to cover a broad spectrum of therapies ranging from medical treatment up to invasive devices, thereby discussing the available options from the emergency department to the intensive care unit.
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PMID:Problem-based review: The patient with acute heart failure. 2353 76

Acute heart failure in patients with severe aortic stenosis and left ventricular systolic dysfunction is well known for its dire prognosis and limited therapeutic options. The authors describe the case of a man admitted for non-ST-elevation myocardial infarction. Diagnostic exams revealed severe aortic stenosis, with good left ventricular systolic function, and two-vessel coronary artery disease. The development of cardiogenic shock with left ventricular systolic dysfunction on day four led to changes in the therapeutic strategy. Percutaneous aortic balloon valvuloplasty coupled with complete myocardial revascularization was performed with a view to future surgical intervention. After discharge, the patient was readmitted with acute pulmonary edema, cardiogenic shock and cardiopulmonary arrest. Ventilator weaning was not possible due to acute heart failure and so it was decided to administer levosimendan, which resulted in substantial clinical and echocardiographic improvement. The patient subsequently underwent successful aortic valve replacement. This case highlights the challenge that characterizes the management of patients with concomitant coronary artery disease, left ventricular systolic dysfunction and severe aortic stenosis. Percutaneous aortic balloon valvuloplasty and levosimendan were safe and effective in the treatment of acute heart failure, acting as a bridge to surgery.
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PMID:[Severe aortic stenosis and cardiogenic shock: a therapeutic challenge]. 2384 22


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