Acute heart failure – a revision
Keywords:
heart failure, BNP, atrial fibrillationAbstract
Heart failure (HF) is a disease of the elderly and an important
public health problem, due to a greater life span and multiple
risk factor prevalence in developed societies, particularly arterial hypertension and coronary disease.
The clinical syndrome of Acute Heart Failure (AHF) may present
as acute new onset HF or as decompensated Chronic Heart Failure.
Diagnosis is made mainly in a clinical basis, supported by
complementary diagnostic tests, namely plasma brain natriuretic peptide (BNP), chest X-ray, electrocardiogram (ECG) and
Echocardiography.
The aim of therapy of AHF is to correct hypoxia, increase cardiac
output, renal perfusion, sodium excretion and urine output. It´s
essential to maintain SaO2 > 94%, to promote vasodilatation by
nitrates use, to force the diuresis with furosemide (continuous
infusion after intravenous bolus) and correct the metabolic
disturbances and organ-specific dysfunctions (particularly the renal one).
Further specific therapies (e.g., the use of inotropic agents),
should be administered based on the clinical and haemodynamic
characteristics of the patient who does not respond to initial treatment.
The scientific societies have been producing Guidelines and
Consensus with regularity, being the one of the European Society
of Cardiology (2005), a very important bibliographical source in the present revision.
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References
Guidelines on the diagnosis and treatment of acute heart failure. Available at http://www.escardio.org.
ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult, 2001. http://www.acc.org/clinical/guidelines/failure/hf_index.htm.
Givertz MM, Colucci WS, Braunwald E. Clinical aspects of Heart failure; Pulmonary edema, high-output failure, 22. Zipes D, Libby P, Bonow R,
Braunwald E. eds. Braunwald´s Heart Disease a textbook of cardiovascular medicine. Philadelfia: Elsevier Saunders 2005: 539-568.
Dickstein K. Diagnosis and assessment of the heart failure patient: the cornerstone of effective management, Eur J Heart Fail 2005, 7: 303-308.
PRODIGY Guidance - Heart failure. http://www.prodigy.nhs.uk/guidance.asp?gt=Heart%20failure.
Guidelines for the diagnosis and treatment of chronic heart failure: full text (update 2005). Available at http://www.escardio.org.
Silver MA, Mainel A, Yancy C et al. For the BNP consensus panel 2004. BNP consensus panel 2004: A clinical approach for the diagnostic, prognostic, screening, treatment monitoring, and therapeutic roles of natriuretic peptides in cardiovascular diseases. Congest Heart Fail 2004; 5 (3): 1-28.
Logeart D, Thabut G, Jourdain P et al. Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after descompensated heart failure. J Am Coll Cardiol 2004; 43:635-641.
Doust JA, Pietrzak E, Dobson A et al. How well does B-type natriuretic peptide predict death and cardiac event in patients with heart failure: systematic review, BMJ 2005; 330: 625-627.
Bersten AD, Holt AW, Vedig AE et al. Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. N Eng J Med 1991; 325: 1825-1830.
Kelly CA, Newby DE, Mcdonagh TA et al. Randomised controlled trial of continuous positive airway pressure and standard oxygen therapy in acute pulmonary oedema; effects on plasma brain natriuretic peptide concentrations. Eur Heart J 2002; 23:1379-1386.
Martins S, Matos P, Soares RM. Insuficiência Cardíaca, 9. Ponce P. ed. Manual de Terapêutica Médica 1. Lisboa: Lidel- edições técnicas 2002: 97-113.
Lowes BD, Tsvetkova T, Eichhorn EJ et al. Milrinone versus dobutamine in heart failure subjects treated chronically with carvedilol. Int J Cardiol 2001; 81:141-149.
Metra M, Nodari S, D´Aloia A et al. Beta-blocker therapy influences the hemodynamic response to inotropic agents in patients with heart failure: a randomised comparison of dobutamine and enoximone before and after chronic treatment with metoprolol or carvedilol. J Am Coll Cardiol 1997; 30:992-996.
Cleland JG, McGowan J. Levosimendan: a new era for inodilator therapy for heart failure? Curr Opin Cardiol 2002; 17:257-265.
Follath F, Cleland JG, Just H et al. Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomised double-blind trial. Lancet 2002; 360:196-202.
Naka Y, Chen J, Rose E. Assisted circulation in the treatment of heart failure, 25. Zipes D, Libby P, Bonow R, Braunwald E. eds. Braunwald´s Heart Disease a textbook of cardiovascular medicine, vol.1, 7th edition. Philadelfia: Elsevier Saunders 2005: 625-639.
Smith SC Jr, Dove JT, Jacobs AK, et al. ACC/AHA guidelines for percutaneous coronary intervention: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2001; 37:2239i.
National Guideline Clearinghouse. Inpatient management of heart failure. Available at http://www.guideline.gov.
Panagiotis K, Theofilos MK, John AG et al. Errors and pitfalls in the non-invasive management of atrial fibrillation. Int J Cardiol 2005: 1-6.
Josephson ME, Zimetbaum P. The Tachyarrhytmias, 214. Dennys LK et al. eds. Harrison´s Principles of Internal Medicine, 16th edition. New York: Mc Graw-Hill 2005: 1342-1358.
Longmore M, Wilkinson I, Török E. Oxford handbook of clinical medicine, 5th edition. Oxford: Oxford University Press 2001: 114.
Fuster V, Ryden LE, Asinger RW et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task force on the Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology. Eur Heart J 2001; 22:1852-1923.
Thery C, Asseman Ph, Elvas L. Fibrilhação auricular. Teixeira F, Maldonado J, Teixeira L. eds. Manual Europeu de Terapêutica Cardiovascular. ENOTT, Terapêutica geral/Farmacologia clínica. Faculdade de Medicina de Coimbra 1977: 133-140.
Ramos J. Doença coronária aterosclerótica, 1. Ponce P. ed. Manual de terapêutica médica 1. Lisboa: Lidel - edições técnicas 2002: 3-47.
Morton FA, Leonard IG, Warren JM. Restoration of sinus rhythm in atrial fibrillation: recommendations. UpToDate 13.2, 2005.
Dittrich HC, Erickson JS, Schneiderman T et al. Echocardiographic and clinical predictores for outcome of elective cardioversion of atrial fibrillation. Am J Cardiol 1989; 63:193.
Hoghund C, Rosenhame G. Echocardiographic left atrial dimension as a predictor of maintaining sinus rhythm after cardioversion of atrial fibrillation. Acta Med Scand 1985; 217:411.
Pereira E. Antiarrítmicos, 36. Garret J, Osswald W, Guimarães S. eds. Terapêutica medicamentosa e suas bases farmacológicas, vol.I, 3ª edição. Porto: Porto Editora 1994: 507-536.
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