Management – ABC CARDIOL

ABCHF

Case Report

Management of Patients with Advanced Heart Failure According to Hemodynamic Parameters

Carlos Aurélio dos Santos Aragão et al. Daniella Motta da Costa Dan Mônica Samuel Ávila

Introduction

Heart failure (HF) is characterized by progressive functional or structural worsening of the myocardium. Despite significant therapeutic advances that have improved survival and quality of life, HF still has high morbidity and mortality rates. Patients with HF may progress with refractory disease, whose gold standard treatment is heart transplantation (HT).^,

The assessment of pulmonary hemodynamics is indicated for HT candidates. The presence of fixed pulmonary hypertension (PH) is a contraindication for HT because it promotes right ventricular (RV) dysfunction in the graft, reducing post-HT survival. In addition, the assessment of hemodynamic parameters helps in bedside therapeutic management, including in the setting of PH, favoring HT indication.^, We report a successful case of optimal bedside therapy guided by invasive hemodynamic parameters.

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Case Report

Profound Sustained Hypotension Following Renal Denervation: A Dramatic Success?

Ganiga Srinivasaiah Sridhar et al. Timothy Watson Chee Kok Han Wan Azman Wan Ahmad

Introduction

A 67-year-old woman with drug-refractory essential hypertension was admitted for renal sympathetic denervation (RDN). The secondary causes of hypertension were fully investigated in this patient. A 24-h ambulatory blood pressure (BP) monitor documented a mean daytime BP of 172/101 mmHg, a mean nighttime BP of 151/84 mmHg, and an overall mean BP of 167/97 mmHg despite compliance with metoprolol (50 mg twice daily), amlodipine (10 mg once daily), lisinopril (20 mg once daily), prazosin (2 mg thrice daily), and hydrochlorothiazide (50 mg once daily).

The patient was fasted for 4 h. Her usual antihypertensive drug therapy was continued. After the administration of 5,000 international units of heparin and 100 μg of fentanyl, a 7-F Renal Double Curve guide catheter (Cordis Corporation, Fremont, CA ,USA) was inserted into the right renal artery (no accessory vessel). A 0.014-in Runthrough floppy guide wire (Terumo Medical Corporation, Somerset, NJ, USA) was advanced into place. A 6-mm ONESHOT^TM (Covidien, Mansfield, MA, USA) irrigated RDN balloon was advanced into place (), and a single ablation was performed. The procedure was then repeated on the other side. The patient remained hemodynamically stable throughout and at the completion of the procedure with a BP of 150/80 mmHg. Hemostasis was achieved with the Perclose ProGlide Suture-Mediated Closure System (Abbott Vascular, Santa Clara, CA, USA), and the patient was then returned to our ward for monitoring.

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Artigo Original

Perceptions of heart failure diagnosis and management: comparison between clinical cardiologists and family doctors

Leandro Reis Tavares et al. Luis Guilhermo Cocca Velarde Verônica Alcoforado de Miranda Evandro Tinoco Mesquita

OBJECTIVE: To compare the perceptions of heart failure (HF) diagnosis and management between clinical cardiologists (CC) and family doctors (FD) in the city of Niterói. METHODS: A qualitative questionnaire, validated by the EURO-HF study, was submitted to 54 FD and 62 CC. These professionals supplied the following information: HF diagnosis; availability of complementary tests; which tests were used more often; names, dosages and adverse effects of the medications prescribed; and which pharmaceuticals reduced mortality. RESULTS: FD and CC reported that the most common signs and symptoms identified by HF patients were: dyspnea, edema and fatigue (96.3% vs. 100%, 74% vs. 58% and 22.2% vs. 67.7%). The HF classification method used most often by FD was mild/moderate/severe (53.8%) while the CC used the NYHA method (72.7%) more often. CC request echocardiograms more often than FD (p < 0.001). CC differentiate HF with preserved systolic function from HF with systolic dysfunction more often than FD (p < 0.001). CC use beta-blockers (p < 0.001), angiotensin-converting enzyme inhibitors (p < 0.001) and spironolactone (p < 0.001) more often than FD. The angiotensin-converting enzyme (ACE) inhibitor dosages used by CC are greater than those used by FD (p < 0.001) and the spironolactone dosages used by CC are closer to those recommended in medical literature. CONCLUSION: CC use a more intensive investigative diagnosis and medications that are more effective in reducing morbidity and mortality rates for HF patients.

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Management of Patients with Advanced Heart Failure According to Hemodynamic Parameters

Introduction

Profound Sustained Hypotension Following Renal Denervation: A Dramatic Success?

Introduction

Perceptions of heart failure diagnosis and management: comparison between clinical cardiologists and family doctors

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Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)