The role of cardiac power and systemic vascular resistance in the pathophysiology and diagnosis of patients with acute congestive heart failure

Cotter, Gad; Moshkovitz, Yaron; Kaluski, Edo; Milo, Olga; Nobikov, Ylia; Schneeweiss, Adam; Krakover, Ricardo; Vered, Zvi

doi:10.1016/s1388-9842(03)00100-4

Cited by 151 publications

(51 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This may be explained by a reduction of afterload as a consequence of high dosage nitrate treatment, which in turn increases the stroke volume and thus counters hypotension. A reduction of afterload appears to be particularly beneficiary for patients with pulmonary edema, who often have an increased afterload and a small stroke volume [6]. There appears to be a need for randomized, blinded studies to verify the described effects of high dose nitrate treatment, particularly with regard to mortality.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Medical and Ventilatory Treatment of Acute Heart Failure: New Insights

Hodt

Steine²,

Atar³

2006

Cardiology

View full text Add to dashboard Cite

Background: The traditional medical treatment of acute heart failure (AHF) has remained unchanged for many years. It has been based on oxygen supplementation and mechanical ventilatory support as well as the administration of morphine, diuretics, nitrates and inotropic agents. In 2005 the European Society of Cardiology (ESC) published new guidelines on the diagnosis and treatment of AHF. Also, new therapies have been introduced recently, giving rise to changes in therapeutic concepts. Material/Method: Based on these new guidelines and recent studies selected from the literature we here describe the new ESC classification of AHF including its epidemiology and pathophysiology. We further present a state-of-the-art status of the choices of medical treatment for patients with acute decompensated heart failure and pulmonary edema. Results: Mechanical ventilatory support reduces the number of patients who require endotracheal intubation.Nitrates in dosages higher than employed today appear to be beneficiary to patients with pulmonary congestion, probably because of the pronounced afterload-reducing effect. Nesiritide, a synthetic brain natriuretic peptide, has shown better hemodynamic effects than common nitrate dosages in patients with congestive heart failure. Tezosentan, an endothelin antagonist, was tested in the biggest AHF trial ever, which, however, was terminated prematurely because it was futile to proceed given the endpoints dyspnea and death. The β₁-adrenergic drug dobutamine and the phosphodiestherase inhibitor milrinone are associated with increased mortality in patients with pronounced chronic and acute congestive heart failure. Levosimendan, a new inotropic drug, has shown lower mortality compared to dobutamine in patients with acute congestive heart failure. Conclusion: New concepts have finally emerged, including the application of old drugs such as nitrates in new (i.e., higher) dosages, as well as the novel compound levosimendan, recommended for patients with AHF and hypoperfused organs. The new ESC classification of AHF provides a valuable and long-awaited guideline to diagnose and treat this severe condition.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Patients with acute decompensated heart failure may have either low, normal or high cardiac output, mildly elevated end-diastolic pressure, or mildly increased total peripheral resistance. Patients with pulmonary edema usually have a low cardiac volume, elevated end-diastolic pressure and increased total peripheral resistance [5, 6]. …”

Section: Pathophysiologymentioning

confidence: 99%

Medical and Ventilatory Treatment of Acute Heart Failure: New Insights

Hodt

Steine²,

Atar³

2006

Cardiology

View full text Add to dashboard Cite

show abstract

“…C PI ("cardiac power index") verdeutlicht den Zusammenhang zwischen kardiovaskulärem Blutfluss (Herzzeitindex; CI) und mittlerem arteriellem Druck (MAD) und berechnet sich nach folgender Formel [56]:…”

Section: Herzzeitvolumenunclassified

Akute Herzinsuffizienz

Janssens

2012

Med Klin Intensivmed Notfmed

View full text Add to dashboard Cite

Acute decompensated heart failure (ADHF) is a major public health problem throughout the world and its importance is continuing to grow. More than 50% of ADHF patients have coronary artery disease, which is generally associated with a history of hypertension. Recent data suggest that half of the patients presenting with acute heart failure have preserved left ventricular systolic function. The diagnosis of ADHF may be difficult at times, and the clinical assessment and patient profiling is essential for appropriate therapy. Immediate therapeutic goals are not only to improve symptoms, restore oxygenation and stabilize hemodynamic conditions, but also to improve short- and long-term survival. In addition to general supportive measures such as oxygen supplementation, noninvasive ventilation, analgesia, diuretics, vasodilators together with inotropic agents and/or vasopressors remain the cornerstone of therapy in patients with ADHF.

show abstract

“…Effective use of risk stratification algorithms to direct management of patients suffering of AHF is becoming increasingly important. A great investigative effort has been made to identify clinical predictors of morbidity and mortality among patients with AHF [6,7,8,9,10,11,12,13,14,15,16,17,18,19]. Recent analysis of large databases like ADHERE, OPTIMIZE-HF and OPTIME-CHF has allowed development of a simple risk stratification scheme based on data that are easily obtained in the emergency department setting [1,2,3,20,21,22].…”

Section: Introductionmentioning

confidence: 99%

Rapid Clinical Assessment of Patients with Acute Heart Failure: First Blood Pressure and Oxygen Saturation – Is That All We Need?

et al. 2009

Self Cite

View full text Add to dashboard Cite

The risk stratification of patients with acute heart failure (AHF) has been addressed repeatedly in recent years. Low oxygen saturation (SaO₂) and systolic blood pressure (SBP) are signs of impending respiratory and circulatory failure that can be obtained quickly in patients with AHF. Methods: Admissions for AHF (340 patients) in a city hospital were recorded and patients were followed for symptoms of heart failure, re-admission and mortality for 6 months. Results: Patients with low (<90%) SaO₂ had higher rates of worsening heart failure at 1 month and 6 months (p < 0.001 and p < 0.001, respectively) and higher rates of mortality (p = 0.013). SBP <120 mm Hg was not associated with a significant increase in worsening heart failure, but was associated with a statistically significant increase in mortality at 1 and 6 months (p < 0.001 and p < 0.001, respectively). Combined low SaO₂ and SBP had a particularly strong prognostic implication. Patients who developed frank respiratory failure and/or circulatory failure fared the worst. Patients requiring ventilatory support had a recurrent heart failure rate of 81% and a mortality of 41% at 1 month of follow-up. Patients requiring intravenous pressors without respiratory mechanical support had a recurrent heart failure rate of 72% and a mortality rate of 28% at 1 month (p < 0.001). Conclusions: Simple assessment of impending respiratory and circulatory failure at admission by measuring SaO₂ and SBP enables rapid and accurate risk stratification of patients admitted for AHF. This may enable more aggressive therapeutic interventions for stabilization and treatment of AHF.

show abstract

The role of cardiac power and systemic vascular resistance in the pathophysiology and diagnosis of patients with acute congestive heart failure

Cited by 151 publications

References 22 publications

Medical and Ventilatory Treatment of Acute Heart Failure: New Insights

Medical and Ventilatory Treatment of Acute Heart Failure: New Insights

Akute Herzinsuffizienz

Rapid Clinical Assessment of Patients with Acute Heart Failure: First Blood Pressure and Oxygen Saturation – Is That All We Need?

Contact Info

Product

Resources

About