| Acute heart failure: a novel approach to its pathogenesis and treatment. | |
| | |
MedLine Citation:
|
PMID: 12034145 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Acute heart failure (HF) is one of the most common syndromes in emergency medicine, however, its exact pathogenesis has remained largely unknown. Based on clinical and hemodynamic data we have sub-divided acute HF into four syndromes: cardiogenic shock, pulmonary edema, hypertensive crisis and exacerbated HF. Cardiogenic shock is caused by a severe reduction in cardiac power which is not met by an adequate increase in peripheral vascular resistance leading to significant decrease in blood pressure and end organ perfusion. Hence the treatment of cardiogenic shock should be directed at improving cardiac performance (by optimizing filling pressure, intra-aortic balloon pump and immediate revascularization) and administration of peripheral vasoconstrictors. The other acute HF syndromes (pulmonary edema, HTN crisis and exacerbated HF) are caused by a combination of progressive excessive vasoconstriction superimposed on reduced left ventricular functional reserve. The impaired cardiac power and extreme vasoconstriction induce a vicious cycle of afterload mismatch resulting in a dramatic reduction of CO and elevated left ventricular end diastolic pressure, which is transferred backwards to the pulmonary capillaries yielding pulmonary edema. Therefore, the immediate treatment of these acute HF syndromes should be based on the administration of strong, fast-acting intravenous vasodilators such as nitrates or nitroprusside. After initial stabilization, therapy should be directed at reducing recurrent episodes of acute HF, by prevention of repeated episodes of excessive vasoconstriction along with efforts to optimize cardiac function. |
| | |
Authors:
|
Gad Cotter; Yaron Moshkovitz; Olga Milovanov; Ahmed Salah; Alex Blatt; Ricardo Krakover; Zvi Vered; Edo Kaluski |
Related Documents
:
|
9596425 - Response times and outcomes for cardiac arrests in las vegas casinos. 16931995 - The vasopressin system: physiology and clinical strategies. 19964325 - Shock induced electrical activation in structurally detailed models of pig left-ventric... 8722585 - Defibrillation shocks over epicardial patches produce sympathetic neural dysfunction in... 22451445 - Novel functional risk factors for the prediction of cardiovascular events in vulnerable... 16966855 - Atrial natriuretic peptide: could it be a marker for postoperative recurrent effusions ... |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: European journal of heart failure Volume: 4 ISSN: 1388-9842 ISO Abbreviation: Eur. J. Heart Fail. Publication Date: 2002 Jun |
Date Detail:
|
Created Date: 2002-05-29 Completed Date: 2002-10-16 Revised Date: 2011-06-08 |
Medline Journal Info:
|
Nlm Unique ID: 100887595 Medline TA: Eur J Heart Fail Country: Netherlands |
Other Details:
|
Languages: eng Pagination: 227-34 Citation Subset: IM |
Affiliation:
|
Clinical Pharmacology Research Unit, The Cardiology Institute, Assaf-Harofeh Medical Center, Zerifin, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. cotterg@hotmail.com |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Acute Disease Heart Failure / drug therapy*, etiology* Hemodynamics Humans Hypertension / drug therapy, etiology Pulmonary Edema / drug therapy, etiology Shock, Cardiogenic / drug therapy, etiology Syndrome Vascular Resistance |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Postnatal maternal deprivation aggravates experimental autoimmune encephalomyelitis in adult Lewis r...
Next Document: Chemotherapy-induced cardiotoxicity: current practice and prospects of prophylaxis.