Heart failure, acute clinical presentation

Clinical Presentation and Diagnosis of Acute Heart Failure... 

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.)... 

Imaging of myocardial apoptosis As mentioned above, cardiomyocyte apoptosis is a pathologic feature of heart failure. A characteristic feature of apoptosis is the exter-nahzation of phosphatidylserine phosphoh-pids [135] - a lipid that, under normal conditions, is present in only the inner layer of the cell membrane. Radiolabeled aruiex-in V, an intracellular phospholipid-binding protein, was used clinically in patients with acute myocardial infarction for the non-invasive imaging of apoptosis [136]. Moreover, the use of NIR fluorochrome-tagged annexin V has also been described [137]. 

While several oncologic drugs have been associated with cardiomyopathy, anthracyclines such as daunorubicin and doxorubicin are salient examples. Anthracycline-induced cardiotoxicity may be defined as acute, early-onset chronic, and late-onset chronic (Cardinale et al. 2015). Acute cardiotoxicity occurs after a single dose, or a single course, of anthracyclines, and the onset of clinical manifestations is within 2 weeks from the end of treatment. Early-onset chronic toxicity develops within 1 year, and is the most frequent and clinically relevant form of cardiotoxicity. It usually presents as a dilated and hypokinetic cardiomyopathy leading to heart failure. Late-onset chronic cardiotoxicity develops years, or even decades, after the end of chemotherapy (Cardinale et al. 2015). 

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