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Acute Decompensated Heart Failure

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Book cover Cardiovascular Hemodynamics

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Heart failure is a common condition associated with significant morbidity and mortality. Acute decompensated heart failure is the leading cause of hospitalization among elderly patients in the USA. The hemodynamic categorization of patients with acute heart failure is based on the intracardiac filling pressures and the adequacy of cardiac output. Much of the information required to assess these patients can be derived from the clinical examination. Noninvasive hemodynamic assessment with Doppler echocardiography is helpful in the management of heart failure patients and may provide important information at the time of acute decompensation. Right heart catheterization with placement of a pulmonary artery catheter is generally reserved for patients in whom hemodynamics remain uncertain despite optimal clinical and noninvasive evaluation. The primary goal of treatment is to relieve congestion rather than increasing cardiac output.

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References

  1. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, et al. Heart disease and stroke statistics–2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119(3):480–6.

    Article  PubMed  Google Scholar 

  2. Kupari M, Lindroos M, Iivanainen AM, et al. Congestive heart failure in old age: prevalence, mechanisms and 4–year prognosis in the Helsinki Ageing Study. J Intern Med. 1997;241:387–94.

    Article  PubMed  CAS  Google Scholar 

  3. Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355:251–9.

    Article  PubMed  CAS  Google Scholar 

  4. Fonarow GC, Adams KF, Abraham WT, et al. Risk stratification for in-hospital mortality in acutely decompensated heart failure. JAMA. 2005;293:572–80.

    Article  PubMed  CAS  Google Scholar 

  5. Drazner MH, Hamilton MA, Fonarow GC, et al. Relationship between right and left-sided filling pressures in 1000 patients with advanced heart failure. J Heart Lung Transplant. 1999;18:1126–32.

    Article  PubMed  CAS  Google Scholar 

  6. Drazner MH, Prasad A, Ayers C, et al. The relationship of right- and left-sided filling pressures in patients with heart failure and preserved ejection fraction. Circ Heart Fail. 2010;3(2):202–6.

    PubMed  Google Scholar 

  7. Campbell P, Drazner MH, Kato M, et al. Mismatch if right- and left-sided filling pressures in chronic heart failure. J Card Fail. 2011;17(7):561–8.

    Article  PubMed  Google Scholar 

  8. Drazner MH, Brown RN, Kaiser PA, et al. Relationship of right- and left-sided filling pressures in patients with advanced heart failure: a 14-year multi-institutional analysis. J Heart Lung Transplant. 2012;31(1):67–72.

    Article  PubMed  Google Scholar 

  9. Drazner MH, Hellkamp AS, Leier CV, et al. Value of clinician assessment of hemodynamics in advanced heart failure: the ESCAPE trial. Circ Heart Fail. 2008;1:170–7.

    Article  PubMed  Google Scholar 

  10. From AM, Lam CS, Pitta SR, et al. Bedside assessment of cardiac hemodynamics: the impact of noninvasive testing and examiner experience. Am J Med. 2011;124(11):1051–7.

    Article  PubMed  Google Scholar 

  11. Stevenson LW, Perloff JK. The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. JAMA. 1989;261:884–8.

    Article  PubMed  CAS  Google Scholar 

  12. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration with the International Society for Heart and Lung Transplantation. J Am Coll Cardiol. 2009;53(15):e1–90.

    Article  PubMed  Google Scholar 

  13. Nagueh SF, Bhatt R, Vivo RP, Krim SR, Sarvari SI, Russell K, Edvardsen T, Smiseth OA, Estep JD. Echocardiographic evaluation of hemodynamics in patients with decompensated systolic heart failure. Circ Cardiovasc Imaging. 2011;4(3):220–7.

    Article  PubMed  Google Scholar 

  14. Rudski LG, Wyman WL, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2010;23:685–713.

    Article  PubMed  Google Scholar 

  15. Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, Tajik AJ. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation. 2000;102:1788–94.

    Article  PubMed  CAS  Google Scholar 

  16. Mullens W, Borowski AG, Curtin RJ, Thomas JD, Tang WH. Tissue Doppler Imaging in the estimation of intracardiac filling pressures in decompensated patients with advanced systolic heart failure. Circulation. 2009;119:62–70.

    Article  PubMed  Google Scholar 

  17. Armstron WF, Ryan T, editors. Feigenbaum’s echocardiography. 7th edn. Philadelphia: Lippincott Williams & Wilkins; 2009.

    Google Scholar 

  18. Binanay C, Califf RM, Hasselblad V, O’Connor CM, Shah MR, Sopko G, et al. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA. 2005;294(13):1625–33.

    Article  PubMed  Google Scholar 

  19. Lindenfeld J, Albert NM, Bochmen JP, et al. HFSA 2010 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2010;16:e1–194.

    Article  PubMed  Google Scholar 

  20. Liang KV, Hiniker AR, Williams AW, et al. Use of a novel ultrafiltration device as a treatment strategy for diuretic resistant, refractory heart failure: initial clinical experience in a single center. J Cardiol Fail. 1996;12(9):707–14.

    Article  Google Scholar 

  21. Stevenson L, Belili D, Grover-McKay M, et al. Effects of afterload reduction (diuretics and vasodilators) on left ventricular volume and mitral regurgitation in severe congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 1987;60:654–8.

    Article  PubMed  CAS  Google Scholar 

  22. Rosario LB, Stevenson LW, Soloman SD, et al. The mechanism of decrease in dynamic mitral regurgitation during heart failure treatment: importance of reduction in the regurgitant orifice size. J Am Coll Cardiol. 1998;32:1819–24.

    Article  PubMed  CAS  Google Scholar 

  23. Palardy M, Stevenson LW, Tasissa G, et al. Reduction in mitral regurgitation during therapy guided by measured filling pressures in the ESCAPE trial. Circ Heart Fail. 2009;2:181–8.

    Article  PubMed  Google Scholar 

  24. Mullens W, Abrahams Z, Francis GS, et al. Sodium nitroprusside for advanced low-output heart failure. J Am Coll Cardiol. 2008;52(3):200–7.

    Article  PubMed  CAS  Google Scholar 

  25. Opasich C, Cioffi G, Gualco A. Nitroprusside in decompensated heart failure: what should a clinician really know? Curr Heart Fail Rep. 2009;6(3):182–90.

    Article  PubMed  Google Scholar 

  26. Mullens W, Abrahams Z, Francis GS, et al. Usefulness of isosorbide dinitrate and hydralazine as add-on therapy in patients discharged for advanced decompensated heart failure. Am J Cardiol. 2009;103:113–9.

    Article  Google Scholar 

  27. Cuffe MS, Calif RM, Adams Jr KF, et al. Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial. JAMA. 2002;287:1541–7.

    Article  PubMed  CAS  Google Scholar 

  28. Jennings DL, Thompson ML. Use of combination therapy with a beta-blocker and milrinone in patients with advanced heart failure. Ann Pharmacother. 2009;43(11):172–1876.

    Article  Google Scholar 

  29. Tsvetkova T, Feguson D, Abraham WT, et al. Comparative hemodynamic effects of milrinone and dobutamine in heart failure patients treated chronically with carvedilol. J Card Fail. 1998;4 Suppl 1:36.

    Article  Google Scholar 

  30. Stevenson LW, Tillisch JH. Maintenance of cardiac output with normal filling pressures in patients with dilated heart failure. Circulation. 1986;74:1303–8.

    Article  PubMed  CAS  Google Scholar 

  31. Mullens W, Abrahams Z, Francis GS, et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol. 2009;53:589–96.

    Article  PubMed  Google Scholar 

  32. Winton FR. The influence of venous pressure on the isolated mammalian kidney. J Physiol. 1931;72(1):49–61.

    PubMed  CAS  Google Scholar 

  33. Firth JD, Raine AE, Ledingham JG. Raised venous pressure: a direct cause of renal sodium retention in oedema? Lancet. 1988;1(8593):1033–5.

    Article  PubMed  CAS  Google Scholar 

  34. Kendrick AH, West J, Papouchado M, et al. Direct Fick cardiac output: are assumed values of oxygen consumption acceptable? Eur Heart J. 1988;9:337–42.

    PubMed  CAS  Google Scholar 

  35. Steimle AE, Stevenson LW, Chelimsky-Fallick C, et al. Sustained hemodynamic efficacy of therapy tailored to reduce filling pressures in survivors with advanced heart failure. Circulation. 1997;96:1165–72.

    Article  PubMed  CAS  Google Scholar 

  36. McHugh TJ, Forrester JS, Adler L, Zion D, Swan HJC. Pulmonary vascular congestion in acute myocardial infarction: Hemodynamic and radiologic correlations. Ann Intern Med. 1972;76:29–33.

    Article  PubMed  CAS  Google Scholar 

  37. Bergstra A, Svilaas T, van Veldhuisen DJ, van den Heuvel AF, van der Horst IC, Zijlstra F. Haemodynamic patterns in ST-elevation myocardial infarction: incidence and correlates of elevated filling pressures. Neth Heart J. 2007;15(3):95–9.

    Article  PubMed  CAS  Google Scholar 

  38. Forrester JS, Diamond G, Chatterjee K, Swan HJC. Medical therapy of acute myocardial infarction by application of hemodynamic subsets. N Engl J Med. 1976;295:1361.

    Google Scholar 

  39. Menon V, White H, LeJemtel T, Webb JG, Sleeper LA, Hochman JS. The clinical profile of patients with suspected cardiogenic shock due to predominant left ventricular failure: a report from the SHOCK trial registry. J Am Coll Cardiol. 2000;36:1071–6.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Mazen A. Hanna .

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Grant, A.D.M., Hanna, M.A., Hanna, M.A., Hanna, M.A., Hanna, M.A. (2013). Acute Decompensated Heart Failure. In: Anwaruddin, S., Martin, J., Stephens, J., Askari, A. (eds) Cardiovascular Hemodynamics. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-195-0_13

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  • DOI: https://doi.org/10.1007/978-1-60761-195-0_13

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  • Publisher Name: Humana Press, Totowa, NJ

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