Management of Acute Heart Failure during an Early Phase.
Koji TakagiAntoine KimmounNaoki SatoAlexandre MebazaaPublished in: International journal of heart failure (2020)
Acute heart failure (AHF), a global pandemic with high morbidity and mortality, exerts a considerable economic burden. AHF includes a broad spectrum of clinical presentations ranging from new-onset heart failure to cardiogenic shock. Key elements of the management rely on the clinical diagnosis confirmed on, both, increased natriuretic peptides and echocardiography, and on the prompt initiation of oxygen therapy, including non-invasive positive pressure ventilation, vasodilators, and diuretics. A care pathway is essential, specifically when an acute coronary syndrome is suspected or in the case of cardiogenic shock. Association or increasing doses of vasopressors despite an adequate volume status are markers of progression toward a refractory cardiogenic shock state. For the latter, mechanical circulatory support should be initiated early, optimally before the onset of renal or liver failure. Thus, a tertiary care center is recommended for the management of patients with AHF who require percutaneous coronary intervention or mechanical circulatory support. This narrative review provides multidisciplinary guidance for the management of AHF and cardiogenic shock from pre-hospital to intensive care unit/cardiac care unit, based on contemporary evidence and expert opinion.
Keyphrases
- acute heart failure
- heart failure
- acute coronary syndrome
- intensive care unit
- percutaneous coronary intervention
- healthcare
- liver failure
- left ventricular
- tertiary care
- palliative care
- coronary artery disease
- quality improvement
- hepatitis b virus
- computed tomography
- antiplatelet therapy
- coronavirus disease
- sars cov
- pulmonary embolism
- stem cells
- st elevation myocardial infarction
- coronary artery bypass grafting
- pain management
- chronic pain
- health insurance
- clinical practice
- cell therapy