Heart failure acute decompensated

DiDomenico RJ, Park HY, Southworth MR, et al. Guidelines for acute decompensated heart failure treatment. Ann Pharmacother 2004 38 649-660. 

Adverse effects and contraindications of calcium channel blockers are described in Table 5-2. Verapamil, diltiazem, and first-generation dihydropyridines should also be avoided in patients with acute decompensated heart failure or left... 

FIGURE 8-2. General treatment algorithm for acute decompensated heart failure (ADHF) based on clinical presentation. IV vasodilators that may be used include nitroglycerin, nesiritide, or nitroprusside. Metolazone or spironolactone may be added if the patient fails to respond to loop diuretics and a second diuretic is required. IV inotropes that may be used include dobutamine or milrinone. (D/C, discontinue HF, heart failure SBP, systolic blood pressure.) (Reprinted and adapted from J Cardiac Fail, Vol 12, pages el-el 22, copyright 2006, with permission from Elsevier.)... 

Acute decompensated heart failure, myocarditis, or severe myopathy... 

In an uncontrolled study of 24 patients with acute, decompensated heart failure unresponsive... 

Dobutamine Betai-selective agonist t increases cAMP synthesis Increases cardiac contractility, output Acute decompensated heart failure intermittent therapy in chronic failure reduces symptoms IV only duration a few minutes Toxicity Arrhythmias. Interactions Additive with other sympathomimetics... 

Dopamine Dopamine receptor agonist higher doses activate 13 and a adrenoceptors Increases renal blood flow higher doses increase cardiac force and blood pressure Acute decompensated heart failure shock IV only duration a few minutes Toxicity Arrhythmias Interactions Additive with sympathomimetics... 

Inamrinone, milrinone Phosphodiesterase type 3 inhibitors decrease cAMP breakdown Vasodilators lower peripheral vascular resistance also increase cardiac contractility Acute decompensated heart failure IV only duration 3-6 h Toxicity Arrhythmias Interactions Additive with other arrhythmogenic agents... 

Givertz MM et al The effects of KW-3902, an adenosine Al-receptor antagonist, on diuresis and renal function in patients with acute decompensated heart failure and renal impairment or diuretic resistance. 3 Am Coll Cardiol 2007 50(16) 1551. [PMID 17936154]... 

Abraham WT, Adams KF, Fonarow GC, et al. In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). J Am Coll Cardiol. 2005 46 57-64. 

Keating G, Goa K. Nesiritide—a review of its use in acute decompensated heart failure (Review). Drugs 2003 63 47-70. 

Adverse effects and contraindications of calcium channel blockers are described in Table 16. Verapamil, diltiazem, and first-generation dihydropyridines also should be avoided in patients with acute decompensated heart failure or LV dysfunction because they can worsen heart failure and potentially increase mortality secondary to their negative inotropic effects. In patients with heart failure requiring treatment with a calcium channel blocker, amlodipine is the preferred agent. ... 

HF, heart failure HTN, hypertension ADHF, acute decompensated heart failure PEFHF, preserved ejection fraction HF, heart failure. 

Cardiovascular Transient acute decompensated heart failure occurred in a 19-year-old patient after administration of intravenous propofol 150 mg and fentanyl 100 micrograms [81 ]. Additional precautions should be taken when such drug combinations are used, even in those with normal left ventricular function. 

Chow SL, Houseman D, Phung T, French WJ. Transient acute decompensated heart failure following propofol and fentanyl administration in a healthy 19-year-old patient. Congest Heart Fail 2010 16(2) 80-1. 

Comparative studies Unlike traditional inotropic agents, levosimendan is thought to have a lower potential to cause dysrhythmias, because it does not increase intracellular calcium concentrations and myocardial oxygen consumption. Levosimendan and dobuta-mine have been compared in 50 patients with acute decompensated heart failure (NYHA class III-IV, ejection fraction <35%), mean age 68 years [20 ]. Heart rate and the number of ventricular extra beats increased significantly during infusion of levosimendan and dobutamine, but the increase in ventricular coupled beats was significant only with dobutamine. There were more episodes of non-sustained ventricular tachycardia and paroxysmal atrial fibrillation with levosimendan, but the difference was not significant. 

The prevalence of self-reported illicit use of cocaine and/or metamfetamine in patients with acute decompensated heart failure has been studied, using a multicenter observational registry, in 11 258 patients, of whom 594 (5%) had previously used cocaine (96%) and/or metamfetamine (5%) [29 ]. Users had a median age of 50 years compared with 76 years in nonusers. As there were disproportionately more young African-American men with hypertension, left ventricular systolic dysfunction, and markedly raised B-type... 

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