Prevention of Heart Failure after Myocardial Infarction (Martin St. John Sutton, Section Editor)

Current Heart Failure Reports

, 8:233

First online:

Impact of Systemic Venous Congestion in Heart Failure

  • Matthias DupontAffiliated withDepartment of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic
  • , Wilfried MullensAffiliated withDepartment of Cardiovascular Medicine, Ziekenhuis Oost LimburgSchool of Life Sciences, Transnational University Limburg
  • , W. H. Wilson TangAffiliated withDepartment of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Email author 

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Abstract

Systemic venous congestion is one of the hallmarks of the syndrome of heart failure that results from activation of different deleterious neurohormonal pathways. Apart from contributing to patients’ symptoms and hospital admissions, growing evidence suggests that congestion itself drives further heart failure progression. In addition, systemic venous congestion exerts detrimental effects on other organs (such as kidneys and liver) due to ineffective organ perfusion. Endothelial cell activation, altered ventricular geometry, and functional mitral insufficiency are among the proposed mechanisms. Diuretics and vasodilators remain the mainstay of treatment options, mostly because of poor understanding of the underlying cardiorenal mechanisms involved. Recently, ultrafiltration has emerged as an invasive treatment option in the setting of diuretic resistance. Congestion ideally should be prevented, often initially through water and salt restriction. Early detection, possibly with the help of novel implantable sensor technology, may allow for early detection and intervention long before overt congestion is established.

Keywords

Cardiorenal syndrome Venous congestion Diuretics Edema Heart failure Prevention Treatment Myocardial infarction Diagnostics Early detection