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Management of acute heart failure

ESC Congress 2010

Meet the experts: Management of Acute Heart Failure.

Two clinical cases were presented and discussed with the audience.

Heart Failure (HF)

The first patient, presented by Marco Metra (Brescia, IT), was a 66 year old man with chronic ischemic heart failure acutely decompensated presenting several episodes of acute pulmonary oedema. The patient had a previous history of myocardial infarction (various episodes) with multiple revascularisation procedures. The discussion focused mostly on the need for mechanical LV assist support and mitral valve surgery, as severe mitral valve regurgitation was identified.

The second case, presented by Alex Mebazaa was an 86 year old man with chronic heart failure admitted to the hospital with dyspnoea and hypotension. As the patient auscultation and chest X Ray were normal, the discussion focused on identifying possible reasons for his hypotension and low cardiac output; pulmonary embolism was evoked as the possible cause for the symptoms.

The heart failure guidelines were reviewed at the end of the session, focusing on the main problems in both patients:

  • For pulmonary congestion, diuretics and vasodilators are the first choice if blood pressure is above 100mmHg, although the level of evidence from clinical trials is very limited.
  • In the presence of hypotension, inotropic drugs are recommended, although the level of evidence for benefit is also limited.
  • Renal dysfunction is always a clinical problem. Ace-I, ARBs and aldosterone blockers can be used with caution. In selected patients, dialysis may be of benefit.
  • Before hospital discharge, it is strongly recommended that the patient receive appropriate medical therapy for chronic treatment, including ACE-I, betablockers and aldosterone blockers. In addition, ICD implantation should be considered in clinical class II-III patients with LVEF<35% and reasonably good life expectancy, and at least 40 days after an episode of AMI. CRT therapy is indicated in class III-IV patients with LVEF and QRS > 120 ms.




Management of acute heart failure

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.