Current heart failure reports
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Curr Heart Fail Rep · Jun 2010
ReviewRelaxin: review of biology and potential role in treating heart failure.
Relaxin is a naturally occurring human peptide initially identified as a reproductive hormone. More recently, relaxin has been shown to play a key role in the maternal hemodynamic and renal adjustments that accommodate pregnancy. ⋯ In addition, the other known biologic properties of relaxin, including anti-inflammatory effects, extracellular matrix remodeling effects, and angiogenic and anti-ischemic effects, all may play a role in potential benefits of relaxin therapy. Ongoing, large-scale clinical testing will provide additional insights into the potential role of relaxin in the treatment of heart failure.
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Curr Heart Fail Rep · Dec 2009
ReviewHyperkalemia in patients with heart failure: incidence, prevalence, and management.
Multilevel inhibition of neurohormonal activation using angiotensin-converting enzyme inhibitors, beta-blockers, angiotensin receptor blockers, and aldosterone antagonists is the cornerstone of modern heart failure treatment. Use of these agents in optimal doses is associated with significant improvements in heart failure-associated morbidity and mortality but also may increase serum potassium. Because potassium excretion already is impaired in many heart failure patients because of advanced age, diabetes, or chronic kidney disease, the risk of life-threatening hyperkalemia during treatment is significant. This review discusses the mechanisms, incidence, predictors, and management of hyperkalemia in heart failure, emphasizing the importance of careful patient selection for medical treatment and regular surveillance of potassium and creatinine.
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Curr Heart Fail Rep · Sep 2009
ReviewNitroprusside in decompensated heart failure: what should a clinician really know?
Sodium nitroprusside is an older intravenous vasodilator appropriate for acute hospital treatment of patients with congestive heart failure. It is a balanced arterial and venous vasodilator with a very short half-life, facilitating rapid titration. In general, it improves hemodynamic and clinical status by reducing systemic vascular resistance, left ventricular filling pressure, and increasing cardiac output. This review summarizes recently published literature and recent data regarding the use of this intravenous vasodilator in decompensated heart failure patients.
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Curr Heart Fail Rep · Sep 2009
ReviewManaging acute renal failure in patients with acute decompensated heart failure: the cardiorenal syndrome.
In patients with acute decompensated heart failure, worsening renal function during conventional decongestive therapy (cardiorenal syndrome) affects prognosis and the initiation of therapies with known benefit in chronic heart failure. Potential strategies for decongestion in patients who develop cardiorenal syndrome include invasive hemodynamic monitoring to guide therapy, use of continuous diuretic infusions, ultrafiltration, or novel therapy with adenosine or vasopressin receptor antagonists. Clinical trials by the National Heart, Lung, and Blood Institute's Heart Failure Network are currently underway to validate such therapies in patients with acute decompensated heart failure with worsening renal function and to establish novel biomarkers for the early identification of patients who develop cardiorenal syndrome.
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Curr Heart Fail Rep · Sep 2009
ReviewSleep-disordered breathing in acute decompensated heart failure.
Sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA) and central sleep apnea (CSA), is highly prevalent and frequently unrecognized in patients with chronic heart failure (HF). Untreated SDB may worsen acute decompensation of HF and delay recovery by increasing vascular inflammation and oxidative stress, impeding control of the blood pressure, and promoting arrhythmias. ⋯ The presence of CSA is associated with increased mortality in HF patients. Efficacious suppression of central sleep apnea with continuous positive airway pressure therapy may reduce mortality in HF.