Heart failure clinics
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Heart failure clinics · Jan 2009
ReviewSpecial cases in acute heart failure syndromes: atrial fibrillation and wide complex tachycardia.
Hospitalization for acute heart failure syndromes (AHFS) results in substantial in-hospital and postdischarge morbidity and mortality. Management of AHFS presents significant challenges, given the heterogeneity of the patient population and the differing etiologies underlying why patients present with acute decompensation. ⋯ Compounding this challenge is the paucity of evidence on which to base early management. General principles for the management of atrial fibrillation and wide complex tachycardia in the setting of emergency department AHFS are discussed.
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Optimal medical therapy may ameliorate acute cardiogenic shock and long-term congestive heart failure symptoms; however, in certain cases mechanical circulatory assistance may be helpful or even required. Different devices can be considered based on the anticipated duration of need and the acuity of the cardiovascular failure being treated. A working knowledge of balloon pumps and ventricular assist devices, their indications, function, and potential complications, allows the physician to provide optimal care for those patients presenting with such a device.
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Heart failure clinics · Apr 2008
The cholesterol paradox revisited: heart failure, systemic inflammation, and beyond.
The pathophysiologic understanding of chronic heart failure has made significant advances over the last decades. Counterintuitively, high levels of plasma cholesterol are associated with better survival, perhaps because plasma lipoproteins are able to scavenge lipopolysaccharide, a cell-wall component from gram-negative bacteria. ⋯ This article explores the cholesterol paradox in patients who have chronic heart failure and extends this view to patients who have sepsis. Also discussed is the potential of statins, which might be able to exert beneficial effects in both clinical conditions, despite lowering plasma cholesterol values.
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Heart failure clinics · Apr 2008
Investigations of statins in heart failure: inflammatory biomarkers and hormones.
The primary role of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) is to treat dyslipidemia. The clinical benefits with statin therapy have been demonstrated in the primary and secondary prevention of atherosclerotic vascular diseases. More recently, it has been observed that pleiotropic effects of statins (which may or may not be associated with lipid lowering) have been described as treatment of various cardiovascular disease processes and in noncardiac disease processes. This article evaluates the potential mechanisms for these effects in the management of heart failure and postulates their clinical and beneficial use.
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Heart failure clinics · Jul 2007
ReviewSymptomatic relief: left ventricular assist devices versus resynchronization therapy.
In patients who have end-stage heart failure, medical therapy is of limited use, and heart transplantation is frequently not an option because of the shortage of donor hearts. Two new treatment options, left ventricular assist devices (LVADs) and implantable cardiac resynchronization therapy (CRT) devices, can improve survival and quality of life in patients who have heart failure. Both types of devices are easy to implant. ⋯ Therefore, methods must be devised to identify patients who have heart failure who are likely to benefit from these devices. Data suggest that early LVAD implantation, before end-stage heart failure develops, is critical to slowing or reversing disease progression. Similarly, in indicated patients who have less advanced disease, CRT may be particularly beneficial.