Document Detail


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
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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
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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

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