Algorithm for therapeutic management of acute heart failure syndromes.
As for other critically ill diseases, two key factors may markedly improved morbidity and mortality of acute heart failure syndromes (AHFS): early initiation of treatment and tailored therapy. Early initiation aims to stop the negative cascade of heart dysfunction. Tailored therapy should be based on the level of systolic blood pressure at admission and fluid retention. Indeed, EFICA and OPTIMIZE-HF showed that patients with high systolic blood pressure have a left ventricular systolic function that is likely preserved and those with low systolic blood pressure have a lower left ventricular ejection fraction and frequent signs of organ's hypoperfusion. Among the proposed treatments, non-invasive ventilation is the only treatment that was consistently proven to be beneficial on morbidity and mortality in almost all types of AHFS. Concerning pharmacological agents, actions should be taken to increase the use of vasodilators and reduce the use of diuretics.
Chatti
Ramzi
R
Department of Anesthesiology and Critical Care Medicine, Lariboisière Hospital, University Paris 7 Denis Diderot, 2 Rue Ambroise Paré, Paris, 75010, France.
Fradj
Nabil Ben
NB
Trabelsi
Wissem
W
Kechiche
Hakim
H
Tavares
Miguel
M
Mebazaa
Alexandre
A
D000208:Acute Disease; D000465:Algorithms; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D045422:Continuous Positive Airway Pressure; D004232:Diuretics / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D013318:Stroke Volume / Q000187:drug effects; D013577:Syndrome; D013599:Systole / Q000187:drug effects; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy
D002316:Cardiotonic Agents; D002317:Cardiovascular Agents; D004232:Diuretics; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents