Splanchnic Nerve Block for Acute Heart Failure

Fudim, Marat; Jones, W. Schuyler; Boortz-Marx, Richard L.; Garg, Arun; Green, Cynthia L.; Hernandez, Adrian F.; Patel, Manesh R.

doi:10.1161/circulationaha.118.035260

Cited by 67 publications

(61 citation statements)

References 5 publications

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“…10 The proposed mechanisms are summarized in Table 1. 19,37,[67][68][69][70]74,79,82,[88][89][90][98][99][100][101][102][103][104][106][107][108][109] While most people do not undergo CT, MRI, or DXA imaging for purposes of screening for HF, interpreting regional fat distribution when imaging is obtained for other purposes could shed light on subpopulations who are at . increased risk of developing HFpEF.…”

Section: Discussionmentioning

confidence: 99%

“…101,102 Finally, as recently demonstrated, a direct reduction in splanchnic vascular tone or in other words selective increase in splanchnic vascular compliance could lead to central vascular decongestion with potentially beneficial effects on cardiopulmonary performance. 103,104 The role for targeting the abdominal fat burden, elevated IAP, and modulation of vascular-splanchnic coupling in obese HFpEF remains to be studied.…”

Section: Vascular Compliance and Splanchnic Couplingmentioning

confidence: 99%

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Regional adiposity and heart failure with preserved ejection fraction

Rao

Fudim

Mentz

et al. 2020

European J of Heart Fail

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The role of obesity in the pathogenesis of heart failure (HF), and in particular HF with preserved ejection fraction (HFpEF), has drawn significant attention in recent years. The prevalence of both obesity and HFpEF has increased worldwide over the past decades and when present concomitantly suggests an obese-HFpEF phenotype. Anthropometrics, including body mass index, waist circumference, and waist-to-hip ratio, are associated with incident HFpEF. However, the cardiovascular effects of obesity may actually be driven by the distribution of fat, which can accumulate in the epicardial, visceral, and subcutaneous compartments. Regional fat can be quantified using non-invasive imaging techniques, including computed tomography, magnetic resonance imaging, and dual-energy X-ray absorptiometry. Regional variations in fat accumulation are associated with different HFpEF risk profiles, whereby higher epicardial and visceral fat have a much stronger association with HFpEF risk compared with elevated subcutaneous fat. Thus, regional adiposity may serve a pivotal role in the pathophysiology of HFpEF contributing to decreased cardiopulmonary fitness, impaired left ventricular compliance, upregulation of local and systemic inflammation, promotion of neurohormonal dysregulation, and increased intra-abdominal pressure and vascular congestion. Strategies to reduce total and regional adiposity have shown promise, including intensive exercise, dieting, and bariatric surgery programmes, but few studies have focused on HFpEF-related outcomes among obese. Further understanding the role these variable fat depots play in the progression of HFpEF and HFpEF-related hospitalizations may provide therapeutic targets in treating the obese-HFpEF phenotype.

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Section: Discussionmentioning

confidence: 99%

Section: Vascular Compliance and Splanchnic Couplingmentioning

confidence: 99%

Regional adiposity and heart failure with preserved ejection fraction

Rao

Fudim

Mentz

et al. 2020

European J of Heart Fail

Self Cite

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“…Also, increased sympathetic output leads to splanchnic arterial and venous constriction resulting in blood redistribution from the splanchnic capacitance vasculature to the circulatory volume. This increases the effective circulating volume by redistribution, in a state where volume expansion is already present . As a result, venous return and cardiac filling pressures increase .…”

Section: Congestion In Heart Failurementioning

confidence: 99%

“…This increases the effective circulating volume by redistribution, in a state where volume expansion is already present. 13 As a result, venous return and cardiac filling pressures increase. 11 Indeed, the venous capacitance function becomes compromised during states of longstanding venous congestion and/or increased sympathetic activation in acute heart failure.…”

Section: Definition and Mechanisms Of Congestionmentioning

confidence: 99%

The use of diuretics in heart failure with congestion — a position statement from the Heart Failure Association of the European Society of Cardiology

Mullens

Damman

Harjola

et al. 2019

European J of Heart Fail

777

697

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The vast majority of acute heart failure episodes are characterized by increasing symptoms and signs of congestion with volume overload. The goal of therapy in those patients is the relief of congestion through achieving a state of euvolaemia, mainly through the use of diuretic therapy. The appropriate use of diuretics however remains challenging, especially when worsening renal function, diuretic resistance and electrolyte disturbances occur. This position paper focuses on the use of diuretics in heart failure with congestion. The manuscript addresses frequently encountered challenges, such as (i) evaluation of congestion and clinical euvolaemia, (ii) assessment of diuretic response/resistance in the treatment of acute heart failure, (iii) an approach towards stepped pharmacologic diuretic strategies, based upon diuretic response, and (iv) management of common electrolyte disturbances. Recommendations are made in line with available guidelines, evidence and expert opinion.

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“…25 There have been some reports for treatment of postural orthostatic tachycardic syndrome, 27 motility disorders, 28 or treatment of acute heart failure. 29 However, the results of these case studies need to be proven in larger randomized studies.…”

Section: Introductionmentioning

confidence: 99%

Nerve Block Options for Pain Control during Hepatic and Upper Abdominal Minimally Invasive Procedures

Boucher

Benz

Pierotty

et al. 2020

Digestive Disease Interventions

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Availability of minimally invasive abdominal procedures can be restricted in cases of painful procedures, due to limited access to anesthesia support or the more recent avoidance of aerosol generating medical procedures such as intubation. Intravenous sedation, in many cases is insufficient to effectively control the pain, leaving patients to suffer undue discomfort and a medical team stressed by the situation. Regional nerve blocks can offer a solution but are underutilized, likely in large part due to a lack of knowledge of available options.This manuscript describes four different nerve blocks that can be useful for analgesia related to upper abdominal procedures. Available data are reviewed regarding their effectiveness and the technique used to perform them is described. Information provided aims to help decide which is likely to provide the best analgesia depending on the procedure being done. Increase use of these blocks has the potential to improve patient's accessibility to minimally invasive upper abdominal procedures.

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Splanchnic Nerve Block for Acute Heart Failure

Cited by 67 publications

References 5 publications

Regional adiposity and heart failure with preserved ejection fraction

Regional adiposity and heart failure with preserved ejection fraction

The use of diuretics in heart failure with congestion — a position statement from the Heart Failure Association of the European Society of Cardiology

Nerve Block Options for Pain Control during Hepatic and Upper Abdominal Minimally Invasive Procedures

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