![]() Diuretic strategies in patients with acute decompensated heart failure. Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. ![]() 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Prevalence, predictors and clinical outcome of residual congestion in acute decompensated heart failure. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST outcome trial. Global differences in characteristics, precipitants, and initial management of patients presenting with acute heart failure. Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC Heart Failure Long-Term Registry. Current approach to decongestive therapy in acute heart failure. Loop diuretic therapy reduces circulating blood volume, thereby improving intravascular congestion however, these therapies increase plasma osmolality, which might impede translocation of fluid from the tissues to the circulation.Īquaretic drugs, such as vasopressin antagonists, reduce plasma volume and lower plasma osmolality, which might stimulate translocation of fluid from the tissues to the circulation. Intravascular congestion and tissue congestion can be identified and differentiated with the use of specific diagnostic assessments, such as physical examination, biomarkers and imaging techniques. Residual congestion at discharge from hospital is associated with higher rates of death and hospital readmission for heart failure.Ĭongestion can be present predominantly in the vascular system (intravascular congestion) or in the interstitium (tissue congestion), although the majority of patients have a combination of both intravascular and tissue congestion. By contrast, aquaretic drugs (such as vasopressin antagonists) predominantly cause water excretion, which increases the osmolality of the circulating blood, potentially improving translocation of fluid from the tissues to the circulation and thereby relieving tissue congestion.Ĭongestion is the main reason for hospitalization in patients with acute decompensated heart failure. However, the osmolality of the circulating blood decreases with the use of loop diuretics, which might result in less immediate translocation of fluid from the tissues (lungs, abdomen and periphery) to the circulation when the plasma refill rate is exceeded. Treatment with loop diuretics, the current cornerstone of decongestive treatment, reduces circulating blood volume and thereby reduces intravascular congestion. We provide an overview of novel and established biomarkers, imaging modalities and mechanical techniques for identifying each type of congestion. Each of these two forms of congestion has a different pathophysiology and requires a different diagnostic approach. Although the majority of these patients have a combination of both intravascular and tissue congestion, one phenotype can dominate. In this Review, we describe the two different forms of congestion - intravascular congestion and tissue congestion - and hypothesize that differentiating between and specifically treating these two different forms of congestion could improve the outcomes of patients with acute decompensated heart failure. An improved understanding of the pathophysiology of congestion is of great importance in finding better and more personalized therapies. Furthermore, residual congestion before discharge from hospital is associated with a high risk of early rehospitalization and death. However, achieving complete decongestion can be challenging. Congestion is the main reason for hospitalization in patients with acute decompensated heart failure and is an important target for therapy.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |