Herz
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Acute decompensated heart failure (ADHF) has become the leading cause of hospitalization in patients > 65 years of age. Traditional drug therapy for ADHF has remained unchanged for many years including morphine, diuretics, nitrates and inotropic agents in addition to oxygen supplementation and mechanical ventilatory support, if necessary. ⋯ These guidelines emphasize that ADHF is not a disease entity but a complex syndrome with various etiologies and several distinct clinical conditions as a result of systolic and/or diastolic left and/or right ventricular dysfunction. This review article describes the current role of traditional drugs for ADHF as well as the role of newer concepts including vasodilators like the recombinant human brain peptide nesiritide, endothelin antagonists or vasopressin antagonists and newer inotropic agents like the calcium sensitizer levosimendan.
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Acute heart failure and especially its most severe form, cardiogenic shock, remain the final common pathway to death in a substantial number of patients with acute myocardial infarction (MI). Several studies demonstrated that mechanical reperfusion of occluded coronary arteries by percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery improves survival in patients with acute MI and cardiogenic shock. There is strong evidence that intraaortic balloon pump (IABP) support and ventricular assist devices can stabilize hemodynamics in these patients so that revascularization procedures can be safely performed. This article provides an overview of the therapeutic strategies for acute MI with cardiogenic shock, with focus on the role and particularities of different devices used as mechanical circulatory support in these patients.
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Monitoring of the critically ill patient with acute heart failure still remains a special challenge for intensive care physicians. A rapid change of the patients' condition is subject to the underlying disease and even cardiac arrest may occur without preliminary warnings. The continuous monitoring of heart rate and rhythm, as well as noninvasive measurement of blood pressure, body temperature and urine elimination are obligatory components of the so-called standard monitoring. ⋯ Moreover, determination of biochemical markers depends on the clinical problem. The indications for invasive cardiovascular hemodynamic monitoring with pulmonary artery catheter or with less invasive techniques--such as pulse contour analysis or thermal dye dilution technique--must be placed critically. There is no evidence at all that prognosis is changed by implementation of a monitoring technique.