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Effect of cardiogenic shock hospital volume on mortality in patients with cardiogenic shock. J Am Heart Assoc. Picano E, Pellikka PA. Ultrasound of extravascular lung water: Point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema in patients presenting with acute dyspnea: Prevalence of negative chest radiography results in the emergency department patient with decompensated heart failure.

Decompensated heart failure

Clinical, radiographic, and hemodynamic correlations in chronic congestive heart failure: Value of natriuretic peptides in assessment of patients with possible new heart failure in primary care. Incremental value of biomarkers to clinical variables for mortality prediction in acutely decompensated heart failure: Serial high sensitivity cardiac troponin T measurement in acute heart failure: Cardiac troponin and outcome in acute heart failure. N Engl J Med. Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure.

The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. Peripheral venous blood gases and pulse-oximetry in acute cardiogenic pulmonary oedema. Noninvasive ventilation in acute cardiogenic pulmonary edema: A randomized study of out-of-hospital continuous positive airway pressure for acute cardiogenic pulmonary oedema: Diuretics for heart failure.

Cochrane Database Syst Rev. CD [ PubMed ]. Acute applications of noninvasive positive pressure ventilation. Diuretic strategies in patients with acute decompensated heart failure. Decongestion in acute heart failure. Loop diuretic resistance in heart failure: Cardiorenal outcomes after slow continuous ultrafiltration therapy in refractory patients with advanced decompensated heart failure. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema.

Effect of ularitide on cardiovascular mortality in acute heart failure. Serelaxin in addition to standard therapy in acute heart failure: Teerlink JR, Marco M. European Society of Cardiology; Clevidipine in acute heart failure: Agents with vasodilator properties in acute heart failure: Morphine and outcomes in acute decompensated heart failure: Long-term safety of intravenous cardiovascular agents in acute heart failure: Treatment with inotropes and related prognosis in acute heart failure: J Heart Lung Transplant. Short-term survival by treatment among patients hospitalized with acute heart failure: Acute heart failure syndromes in patients with coronary artery disease early assessment and treatment.

Troponin elevation in heart failure prevalence, mechanisms, and clinical implications. Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: Effect of precipitating factors of acute heart failure on readmission and long-term mortality. Actual incidence of global left ventricular hypokinesia in adult septic shock. Use of procalcitonin for the diagnosis of pneumonia in patients presenting with a chief complaint of dyspnoea: The role of procalcitonin in acute heart failure patients.

Procalcitonin-based indication of bacterial infection identifies high risk acute heart failure patients. Risk stratification for in-hospital mortality in acutely decompensated heart failure: Worsening renal function and prognosis in heart failure: Diagnoses and timing of day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia. Gheorghiade M, Peterson ED. Improving postdischarge outcomes in patients hospitalized for acute heart failure syndromes. Effects of beta-blocker withdrawal in acute decompensated heart failure: Managed care interventions for improving outcomes in acute heart failure syndromes.

Am J Manag Care. Discharge education improves clinical outcomes in patients with chronic heart failure. Clinical picture and risk prediction of short-term mortality in cardiogenic shock. PCI strategies in patients with acute myocardial infarction and cardiogenic shock. Experts' recommendations for the management of adult patients with cardiogenic shock. Management of cardiogenic shock. Comparison of norepinephrine-dobutamine to epinephrine for hemodynamics, lactate metabolism, and organ function variables in cardiogenic shock.

A prospective, randomized pilot study. Comparison of dopamine and norepinephrine in the treatment of shock. Intraaortic balloon support for myocardial infarction with cardiogenic shock.


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National trends in the utilization of short-term mechanical circulatory support: Arrigo M, Mebazaa A. Understanding the differences among inotropes. Support Center Support Center. Please review our privacy policy. Excessive use of toxic substances. Drugs exacerbating condition e.

Metabolic or hormonal disorders. Additional acute cardiovascular causes e. Consider ultrafiltration if resistant to diuretics. Consider inotropic agent if hypoperfusion persists. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.

Sign In or Create an Account. Close mobile search navigation Article navigation. Treatment options for acute heart failure in advanced development stage.

Other emerging therapeutic approaches for acute heart failure. Central role of biomarkers in acute heart failure management. Overall conclusions and summary. What is on the horizon for improved treatments for acutely decompensated heart failure? Acute heart failure , Unmet need , Novel therapies , Biomarkers , Organ damage , Clinical management. No significant effect was observed on the other primary endpoint, relief from dyspnoea as assessed with the Likert scale during the first 24 h Figure 1.


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View large Download slide. At 24 h, plasma NT-proBNP levels were reduced in patients receiving ularitide, compared with placebo. Improving care for patients with acute heart failure: Serelaxin for the treatment of acute heart failure: Clinical trials in acute heart failure: Consensus document arising from a European Society of Cardiology cardiovascular round-table think tank on acute heart failure, 12 May A novel therapy for acute heart failure with a range of hemodynamic and non-hemodynamic actions.

Effects of serelaxin in acute heart failure patients with renal impairment: Serelaxin in acute heart failure patients with preserved left ventricular ejection fraction: Effects of serelaxin in subgroups of patients with acute heart failure: The natriuretic peptides system in the pathophysiology of heart failure: Ularitide for the treatment of acute decompensated heart failure: Effects of the renal natriuretic peptide urodilatin ularitide in patients with decompensated chronic heart failure: Dendroaspis natriuretic peptide and the designer natriuretic peptide, CD-NP, are resistant to proteolytic inactivation.

Design, synthesis, and actions of a novel chimeric natriuretic peptide: Pharmacodynamics of a novel designer natriuretic peptide, CD-NP, in a first-in-human clinical trial in healthy subjects. A Phase II, dose-ranging study with CD-NP, a chimeric natriuretic peptide, in acute decompensated heart failure patients with renal compromise. A new approach to inotropic therapy in the treatment of heart failure: Cardiac myosin activators for the treatment of heart failure: Cinaciguat, a soluble guanylate cyclase activator, unloads the heart but also causes hypotension in acute decompensated heart failure.

Cinaciguat, a soluble guanylate cyclase activator: Istaroxime stimulates SERCA2a and accelerates calcium cycling in heart failure by relieving phospholamban inhibition. Effects of istaroxime on diastolic stiffness in acute heart failure syndromes: Calcium upregulation by percutaneous administration of gene therapy in patients with cardiac disease CUPID 2: Molecular mechanism of beta-arrestin-biased agonism at seven-transmembrane receptors.

Cardiorenal actions of TRV, a novel ss-arrestin-biased ligand at the angiotensin II type I receptor, in healthy and heart failure canines: TRV, a novel beta-arrestin biased ligand at the angiotensin II type I receptor, unloads the heart and maintains renal function when added to furosemide in experimental heart failure.

Selectively engaging beta-arrestins at the angiotensin II type 1 receptor reduces blood pressure and increases cardiac performance. Heart failure therapeutics on the basis of a biased ligand of the angiotensin-2 type 1 receptor. Phase 2b proof of concept study in AHF. A novel approach for the acute treatment of heart failure. New therapeutic perspectives with clevidipine: Find articles by Philippe Vieira Pires.

Find articles by Fabiana Goulart Marcondes Braga. Received Feb 15; Accepted Aug This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Decompensated chronic HF acute exacerbation of chronic HF Clinical situation in which there is acute or gradual exacerbation of signs and symptoms of HF at rest in patients previously diagnosed with HF, that requires additional and immediate therapy.

Chart 1 Triggering factors of decompensation in heart failure. NSAIDs, steroids, estrogens, androgens, chlorpropamide, glitazones, minoxidil Negative inotropic drugs: Open in a separate window. Electrocardiography Fundamental in the management of ACS. Laboratory tests Blood count, BUN, creatinine, blood glucose, electrolytes, and urinalysis are simple methods that help define comorbidities, the cause of decompensation, prognosis and treatment.

Biomarkers Biomarkers are useful in the diagnosis and prognosis of DHF. Echocardiography This is the main noninvasive method for the diagnosis of HF. Pulmonary artery catheter It permits the direct analysis of intracardiac and intravascular pressures, as well as of microhemodynamics parameters. Chart 2 Factors of worse prognosis in decompensated heart failure.

Chart 3 Criteria for hospitalization.

Treatment options for acute heart failure in advanced development stage

Monitoring and ventilatory support Patients presenting with any sign of instability should be monitored by continuous electrocardiogram ECG , noninvasive blood pressure and oximetry. Vasodilators Vasodilators act on the preload and afterload, requiring less myocardial consumptions than inotropic drugs. Nitroglycerin 25 Nitroglycerin is a short-acting intravenous vasodilator. Sodium nitroprusside 25 A potent arterial and venous vasodilator, sodium nitroprusside reduces the preload and afterload, thus improving the biventricular systolic performance.

Inotropic agents 26 In patients with low cardiac output, with or without congestion profiles L and C , inotropic therapy may be required to improve tissue perfusion 5. Dobutamine Dobutamine is a beta-adrenergic agonist.

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Milrinone Milrinone is a phosphodiesterase-III inhibitor. Levosimendan Levosimendan is a calcium sensitizer. Vasopressors The most frequently used vasopressors are norepinephine and dopamine, which are indicated in symptomatic hypotension despite correction of volemia.

Management of hypervolemia Diuretics 36 Diuretics reduce extracellular fluids, filling pressures and cardiac cavities, with a consequent improvement of performance, thus promoting fast symptomatic relief of congestion. Hypertonic saline solution A study with patients resistant to oral loop diuretics showed preservation and improvement of the renal function with the use of mL of NaCl solution at a concentration of 1. Ultrafiltration This procedure is performed via a peripheral intravenous line, and can be potentially used in hypervolemic patients, those with frequent rehospitalizations, and on a day-hospital basis.

ESC guidelines for the diagnosis and treatment of acute and chronic heart failure Eur J Heart Fail. International working group on acute heart failure syndromes. Acute heart failure syndromes: Characteristics and outcomes of patients hospitalized for heart failure in the United States: Does this dyspneic patient in the emergency department have congestive heart failure? Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure.

J Am Coll Cardiol. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. Plasma brain natriuretic peptide-guided therapy to improve outcome in heart failure. BNPguided vs symptom-guided heart failure therapy: Exhaled acetone as a new biomaker of heart failure severity. Hemodynamic monitoring in acute heart failure. Risk stratification for in-hospital mortality in acutely decompensated heart failure: The role of the kidney in heart failure.

Acute Heart failure syndromes: Effect of noninvasive positive pressure ventilation on mortality in patients with acute cardiogenic pulmonary oedema: Sodium nitroprusside for advanced low-output heart failure. Vasodilators in the management of acute heart failure. Petersen JW, Felker M. Inotropes in the management of acute heart failure. Continuous intravenous dobutamine is associated with an increased risk of death in patients with advanced heart failure: Short-term intravenous milrinone for acute exacerbation of chronic heart failure: Hemodynamic and neurohormonal effects of continuous infusion of levosimendan in patients with congestive heart failure.

Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure the LIDO study: Levosimendan vs dobutamine for patients with acute decompensated Herat failure. Dopamine and congestive heart failure: Clinical outcomes in patients on betablocker therapy admitted with worsening chronic heart failure. Should betablocker therapy be reduced or withdrawn after episode of decompensaded heart failure? Eur J Heart Failure. Algorithm for therapeutic management of acute heart failure syndromes.

Changes in brain natriuretic peptide levels and bioelectrical impedance measurements after treatment with high-dose furosemide and hypertonic saline solution versus high-dose furosemide alone in refractory congestive heart failure. Hypertonic saline solution for prevention of renal dysfunction in patients with decompensated heart failure.

Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure. Heart Failure Clinical Research Network. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. Miller LW, Guglin M. Patient selection for ventricular assist devices: Sociedade Brasileira de Cardiologia. Support Center Support Center.