Acute Heart Failure Putting the Puzzle of Pathophysiology and Evidence Together in Daily Practice 2nd Edition by Wolfgang Krügẻ ISBN B0742BFSPC 978-3319549736

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ISBN 10: B0742BFSPC
ISBN 13: 978-3319549736
Author: Wolfgang Krügẻ

Acute heart failure is a potentially life threatening situation where correct, rapid therapy can save lives. Information from the latest research and studies has been used to update this text to bring the latest understanding of the pathophysiology together with a practical guide to diagnosis and management using an evidenced based approach.

Since the first edition of Acute Heart Failure, this research has brought to light three important issues to be integrated into a second edition. First, the so-called “vascular heart failure” has been identified as a common and decisive mechanism provoking acute heart failure due to the coupling and interaction between the heart (right and left heart) and the large vessel systems (aorta and pulmonary artery). Second, the interaction and cross-talk between heart and kidneys, the so-called ‘cardiorenal syndrome’ has been identified as another feature of acute heart failure syndromes. Third, we have new knowledge and updated points of views about the development of pulmonary hypertension in patients suffering from heart failure, the group 2 of the classification system of pulmonary hypertension. These are all covered in this second edition.

This revision to a seminal text is a valuable addition to any practitioner who treats patients with acute heart failure and wants a deeper understanding of the condition.

Acute Heart Failure Putting the Puzzle of Pathophysiology and Evidence Together in Daily Practice 2nd Table of contents:

1: Cardiac Physiology and Acute Heart Failure Syndromes

1.1 Cardiac Performance

1.2 The Fundamental Equation of the Circulation

1.3 Preload

1.3.1 Definition

1.3.2 The Frank–Starling Mechanism

1.3.3 Venous Return and CVP in Daily Practice

1.4 Hemodynamic Monitoring

1.4.1 Assessment and Monitoring of Fluid Status

1.4.2 Prediction of Fluid Responsiveness

1.4.2.1 Pressure Measurements

1.4.2.2 Volumetric Measurements

1.4.2.3 Dynamic Parameters

Descending Aortic Blood Flow as a Direct Correlate of SV/CO

Systolic Pressure Variation (SP-V)

Pulse Pressure Variation (PP-V)

Passive Leg Raising (PLR), An Autotransfusion of Fluids

1.4.2.4 Fluid Challenge

1.4.2.5 PiCCO-Monitoring (Pulse-Induced Continuous Cardiac Output)

1.4.2.6 Echocardiography

1.4.3 Arterial Blood Pressure

1.4.3.1 BP and Autoregulation

Kidneys

Brain

Heart

Septic Shock

1.4.3.2 Assessment of Tissue Perfusion

1.5 Afterload

1.5.1 Definition

1.5.2 Vascular Properties, Effective Arterial Elastance, Wall Stress and the Law of LaPlace

1.5.3 Afterload Mismatch and Acute Heart Failure Syndromes

1.5.4 Concluding Remarks

1.6 Contractility

1.6.1 Definition

1.6.2 Measurement and Quantification

1.6.3 Inotropic Medications

1.7 Heart Rate and Contractility

1.8 Diastolic Ventricular Interaction/Interdependence (DVI)

1.8.1 Definition

1.8.2 Septum and Trans-septal Pressure

1.8.3 Pericardium

1.8.4 Pulmonary Hypertension and the Risk of DVI

1.8.5 Acutely Exacerbated Chronic Congestive (Left-Sided or Biventricular) Heart Failure

1.8.6 Conclusions

1.9 Ventriculo-Arterial Coupling

1.9.1 Definition

1.9.2 Arterial Elastance

1.9.3 Ventricular Elastance

1.9.4 Ventriculo-Arterial coupling

1.9.5 Deranged Coupling

1.10 Myocardial and Chamber Stiffness

1.11 Evaluation and Assessment of the Cardiac Performance

1.12 Summary Key Physiology and Pathophysiology

1.12.1 Frank-Starling-Mechanism

1.12.2 Afterload

1.12.3 Systolic Function

1.12.4 Volume Status

1.12.5 Ventriculo-Arterial Coupling

1.12.6 DVI

1.12.7 Myocardial and Chamber Stiffness

1.12.8 Cardiac Power Output/Index

1.12.9 Echocardiography

References

2: Acute Heart Failure Syndromes

2.1 Definition

2.2 Classification of Acute Heart Failure Syndromes (AHFS)

2.3 Aetiology and Epidemiology [4, 14, 27–30]

2.4 Pathophysiology

2.4.1 General Remarks

2.4.2 Special Pathophysiological Issues

2.4.2.1 LVEDP and Congestion

2.4.2.2 Neurohormonal Systems, Endothelial Dysfunction and Inflammation

2.4.2.3 Vascular Properties, AV-Coupling, Afterload Mismatch and the Dual Pathway Concept by Cot

2.4.2.4 Fluid Redistribution, Splanchnic Veins and the Venocentric Input

2.4.2.5 Fluid Accumulation, Venous Congestion and the Link Between Cardiac and Vascular Pathway

2.4.2.6 (Self)-Amplification and Vicious Cycles

2.4.3 Summary

2.5 Diagnosis, Symptoms, Presentation, Important Clinical and Prognostic Data

2.5.1 Symptoms and Diagnosis

2.5.2 Prognostic Indicators

2.5.3 Initial Clinical Assessment, Diagnostic Measures and Considerations

2.5.3.1 Hemodynamic Profiles on Admission

2.5.3.2 Identification of Precipitants of AHFS

2.5.3.3 Other Diagnostic Measures

2.5.3.4 Special Remark: Non-invasive Estimation of Cardiac Index

2.6 Therapy [4, 5, 7, 431, 432, 437, 469–474]

2.6.1 Therapeutic Principles and Goals

2.6.2 Initial Therapeutic Approach

2.6.2.1 Treatment of Underlying Diseases [25, 470, 471, 511, 512, 514]

2.6.2.2 Common Basic Measures

2.6.2.3 Typical and Specific Measures

Diuretics and Ultrafiltration

Vasodilators

Inotropic Drugs

2.6.2.4 Essential, Permanent Medication in the Acute Phase

2.6.2.5 Arrhythmias and Heart Failure

2.6.2.6 Continuous Positive Airway Pressure (CPAP) and Non-­invasive (positive pressure) Ventilat

2.6.2.7 Anticoagulation

2.7 Valvular Heart Diseases Presenting as Heart Failure Overview [661, 662]

2.7.1 Mitral Regurgitation

2.7.2 Mitral Stenosis

2.7.3 Aortic Regurgitation

2.7.4 Aortic Stenosis

2.8 Summary

References

3: Cardiogenic Shock

3.1 Definition

3.2 Epidemiology

3.3 Aetiology

3.4 Pathophysiological Aspects and Special Features

3.4.1 Classical Pathophysiology and New CS Paradigm

3.4.2 The Role and Impact of Hypotension in CS

3.4.3 Myocardial Ischemia and LV-Compliance

3.4.4 The Right Ventricle in CS

3.4.5 Other Acute Causes of a Substantial Impairment in Contractility

3.5 Clinical Features and Diagnostic Remarks

3.5.1 Hypoperfusion

3.5.2 Right Ventricular Infarction

3.5.3 The LVEDP in Cardiogenic Shock

3.5.4 Important Differential Diagnosis of Cardiogenic Shock [3, 40, 225]

3.6 Therapy

3.6.1 Main Therapeutic Strategies

3.6.2 Adjunctive Treatment

3.6.2.1 Maintaining or Re-establishing Appropriate Coronary and Systemic Perfusion

3.6.2.2 Fluid Administration

3.6.2.3 Vasopressor Administration

3.6.2.4 Inotropic Medication

3.6.2.5 Intra-Aortic Balloon Counter Pulsation (IABP)

3.6.2.6 Renal Function

3.6.2.7 Compensation of Acidosis

3.6.2.8 Anticoagulation therapy

3.7 Summary

References

4: Acute Right Heart Failure

4.1 Definitions

4.2 Epidemiology and Aetiology

4.3 Physiology and Pathophysiology

4.3.1 General Physiological and Pathophysiological Issues

4.3.1.1 To Sum Up (see Fig. 4.3)

4.3.2 Special Pathophysiological Issues

4.3.2.1 Diastolic Ventricular Interaction

4.3.2.2 The Role of the Pericardium in Diastolic-Ventricular Interaction

4.3.2.3 Auto-aggravation

4.3.2.4 Series Effect

4.3.2.5 Pulmonary Hypertension and Ischemia

4.3.2.6 The Interventricular Septum and the Apex

4.3.2.7 The Left Ventricle

4.3.2.8 Mechanical Ventilation

4.4 Diagnostic Aspects

4.4.1 Clinical Features

4.4.2 Serum Biomarkers

4.4.3 Electrocardiography

4.4.4 Echocardiography

4.4.5 Invasive Hemodynamic Assessments

4.5 Therapy

4.5.1 Specific Measures (Overview by [1–4, 9, 16, 20, 30, 33, 93, 98, 106, 107])

4.5.2 Adjunctive Therapy [2, 9, 33, 358, 443]

4.5.2.1 Fluid Management and Optimization of Preload, Diuretics

4.5.2.2 Vasopressors: Treatment and Avoidance of Ischaemia

4.5.2.3 Critical RV-Afterload Reduction

Symptomatic Treatment of PH: Vasodilators

4.5.2.4 Improvement of RV Systolic Function/Contractility

4.5.2.5 Intra-Aortic Balloon Pump

4.5.2.6 Hypercapnia and Acidosis

4.5.2.7 Oxygen Therapy

4.5.2.8 AV Sequential Stimulation

4.5.2.9 Mechanical Ventilation

4.5.2.10 Anticoagulation

4.5.2.11 Digoxin

4.6 Summary

References

5: Heart Failure with Normal Left Ventricular Ejection Fraction (HFNEF)

5.1 Definition and General Remarks

5.2 Epidemiolgy and Aetiology

5.3 Aetiopathogenesis and Basic Pathophysiological Issues and Considerations

5.4 Special Pathophysiology

5.4.1 The Pressure-Volume Relation and the Filling Pressure (LVEDP) in HFpEF

5.4.2 Pathomechanisms

5.4.2.1 Diastolic Dysfunction

ECM

Cardiomyocytes

5.4.2.2 Vascular Stiffening and AV-Coupling

5.4.2.3 Systolic Function and Cardiac Reserve

5.4.2.4 PH and RV Dysfunction, DVI

5.4.2.5 Ventricular Dyssynchrony

5.4.2.6 Left Atrial Dysfunction

5.4.2.7 Peripheral Factors

5.5 Diagnosis and Clinical Issues

5.5.1 Symptoms and Signs of Heart Failure

5.5.2 Ejection Fraction

5.5.3 Diastolic Dysfunction, Structural Changes and Bio-markers

5.5.3.1 Natriuretic Peptides

5.5.3.2 Functional and Structural Alterations

5.5.3.3 E/e′ Ratio

5.5.3.4 Inconclusive E/e′ Ratio, Surrogate Markers

5.5.3.5 Invasively Derived Parameters

5.5.3.6 Diastolic Stress Test

5.6 Therapy

References

6: Pulmonary Hypertension in Left Heart Disease

6.1 Definition

6.2 Classification of PH

6.3 Epidemiology of Pulmonary Hypertension due to Left Heart Disease

6.4 Pathophysiology

6.5 Clinical Issues and Diagnosis

6.6 Therapeutic Considerations

References

7: Cardiorenal Syndrome (CRS)

7.1 Definition

7.2 Epidemiology and Prognostic Issues

7.3 Clinical Issues and Diagnosis

7.4 Pathophysiology

7.5 Management

7.5.1 Diuretics

7.5.2 BP/Renal Perfusion Pressure

7.5.3 Further Measures

References

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Tags: Wolfgang Krügẻ, Acute Heart, Evidence Together