Cardiorenal Syndrome in Acute Decompensated Heart Failure

Key Points Staphylococcus is an increasingly important cause of IE in LMICs, and is the leading cause of IE in UMICs  RHD remains the major underlying cardiac pathology of IE in LMICs, identified in almost half of reported cases  The rate of microorganism non-identification is high, reaching up to 60% of IE cases in LMICs, and hampering diagnosis and treatment  Rates of access to surgery in UMICs for complicated IE are as high as in HICs, but remain dismal in lower-middle income countries SynopsisInfective endocarditis (IE) is a rare, life-threatening disease with a mortality rate of upto 25% and significant debilitating morbidities. Although much has been reported on contemporary IE in high income countries, conclusions on the state of IE in low and middle income countries (LMICs) are based on studies conducted before the year 2000. Furthermore, unique challenges in the diagnosis and management of IE persist in LMICs. This article is a review of IE studies conducted in LMICs documenting clinical experiences from the year 2000 to present. We present the causes of IE, management of patients with IE and the prevailing challenges in diagnosis and treatment of IE in LMICs.

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“…59,60 Furthermore, among patients with heart failure which commonly complicates IE, the risk of nephrotoxicity is heightened. 61 …”

Section: Little Capacity For Therapeutic Drug Monitoringmentioning

confidence: 99%

Infective Endocarditis in Low- and Middle-Income Countries

et al. 2017

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“…Indeed, the evidence for the use of diuretics in HF is geared for the treatment of these symptoms and is experience‐based, with a paucity of robust clinical data in relation to improvements in disease mortality (Faris et al ., 2002). Loop diuretics are the most efficacious and potent in alleviating symptoms, both in acute decompensation and chronic disease, but as with all diuretics, they must be carefully titrated against hypokalaemia (excluding potassium sparing), symptomatic hypotension and renal decline (a significant cause of mortality in patients who die from worsening HF (Sarraf et al ., 2009). …”

Section: Evidence‐based Pharmacological Agentsmentioning

confidence: 99%

Present and future pharmacotherapeutic agents in heart failure: an evolving paradigm

Loudon

Noordali

Gollop

et al. 2016

British J Pharmacology

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Many conditions culminate in heart failure (HF), a multi‐organ systemic syndrome with an intrinsically poor prognosis. Pharmacotherapeutic agents that correct neurohormonal dysregulation and haemodynamic instability have occupied the forefront of developments within the treatment of HF in the past. Indeed, multiple trials aimed to validate these agents in the 1980s and early 1990s, resulting in a large and robust evidence‐base supporting their use clinically. An established treatment paradigm now exists for the treatment of HF with reduced ejection fraction (HFrEF), but there have been very few notable developments in recent years. HF remains a significant health concern with an increasing incidence as the population ages. We may indeed be entering the surgical era for HF treatment, but these therapies remain expensive and inaccessible to many. Newer pharmacotherapeutic agents are slowly emerging, many targeting alternative therapeutic pathways, but with mixed results. Metabolic modulation and manipulation of the nitrate/nitrite/nitric oxide pathway have shown promise and could provide the answers to fill the therapeutic gap between medical interventions and surgery, but further definitive trials are warranted. We review the significant evidence base behind the current medical treatments for HFrEF, the physiology of metabolic impairment in HF, and discuss two promising novel agents, perhexiline and nitrite.

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“…Thus, any increase in atrial pressure leads to a diminished release of arginine vasopressin (antidiuretic hormone), increased release of atrial natriuretic peptide, and decreased renal sympathetic tone. 8 However, in patients with acute decompensated heart failure, total blood volume is not the determinant of renal excretion of sodium and water; the integrity of arterial circulation is a key factor in euvolemia. 4 Patients with heart failure have either decreased cardiac output that causes underfilling of the arterial circulation or high cardiac output that prompts systemic arterial vasodilatation and underfilling of the arterial circulation.…”

Section: Pathophysiology Of Hypervolemiamentioning

confidence: 99%

“…Angiotensin II increases synthesis of aldosterone, leading to renal reabsorption of sodium and sodium retention. 8,10 Activation of the sympathetic nervous system leads to elevated plasma levels of norepinephrine that stimulate α-receptors in the nephron, enhancing reabsorption of sodium in the proximal tubules. 8,10 In addition, β-receptors in the juxtaglomerular apparatus stimulate the renin-angiotensinaldosterone system, further enhancing proximal tubular reabsorption of sodium.…”

Section: Pathophysiology Of Hypervolemiamentioning

confidence: 99%

“…8,10 Activation of the sympathetic nervous system leads to elevated plasma levels of norepinephrine that stimulate α-receptors in the nephron, enhancing reabsorption of sodium in the proximal tubules. 8,10 In addition, β-receptors in the juxtaglomerular apparatus stimulate the renin-angiotensinaldosterone system, further enhancing proximal tubular reabsorption of sodium. 8 Normally, atrial natriuretic peptide increases glomerular filtration rate and excretion of water and sodium; however, in advanced heart failure, these effects are attenuated by renal vasoconstriction and a reduction in sodium delivery to the distal nephron.…”

Section: Pathophysiology Of Hypervolemiamentioning

confidence: 99%

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Fluid Management Strategies in Heart Failure

Albert

2012

Critical Care Nurse

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In patients with chronic heart failure, fluid retention (or hypervolemia) is often the stimulus for acute decompensated heart failure that requires hospitalization. The pathophysiology of fluid retention is complex and involves both hemodynamic and clinical congestion. Signs and symptoms of both hemodynamic and clinical congestion should be assessed serially during hospitalization. Core heart failure drug and cardiac device therapies should be provided, and ultrafiltration may be warranted. Critical care, intermediate care, and telemetry nurses have roles in both assessment and management of patients hospitalized with acute decompensated heart failure and fluid retention. Nurse administrators and managers have heightened their attention to fluid retention because the Medicare performance measure known as the risk-standardized 30-day all-cause readmission rate after heart failure hospitalization can be attenuated by fluid management strategies initiated by nurses during a patient’s hospitalization.

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Cardiorenal Syndrome in Acute Decompensated Heart Failure

Cited by 153 publications

References 101 publications

Infective Endocarditis in Low- and Middle-Income Countries

Infective Endocarditis in Low- and Middle-Income Countries

Present and future pharmacotherapeutic agents in heart failure: an evolving paradigm

Fluid Management Strategies in Heart Failure

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