Comprehensive and Safe Decongestion in Acutely Decompensated Heart Failure.
Jason StencelIndranee N RajapreyarRohan SamsonThierry H Le JemtelPublished in: Current heart failure reports (2022)
Analysis of experience with positive inotropic agents, especially dobutamine, indicates that enhancement of cardiac output is not consistently associated with increased renal blood flow. However, urinary output and renal sodium excretion increase likely due to dobutamine-mediated decrease in renal and systemic reduced activation of sympathetic nervous- and renin-angiotensin-aldosterone system. Mechanical circulatory support with left ventricular assist devices ascertained the contribution of low cardiac output to diuretic resistance and the pathogenesis and progression of kidney disease in acutely decompensated heart failure. Diuretic resistance commonly occurs in acutely decompensated heart failure. However, failure to resolve fluid overload despite high doses of loop diuretics should alert to the presence of a low cardiac output state.
Keyphrases
- heart failure
- left ventricular
- acute heart failure
- blood flow
- cardiac resynchronization therapy
- hypertrophic cardiomyopathy
- acute myocardial infarction
- mitral valve
- left atrial
- aortic stenosis
- angiotensin ii
- atrial fibrillation
- angiotensin converting enzyme
- transcription factor
- extracorporeal membrane oxygenation
- clinical decision support
- coronary artery disease
- acute coronary syndrome
- liver failure
- transcatheter aortic valve replacement
- ejection fraction
- drug induced