Heart failure management system

Expert opinion is a source, frequently elicited by survey, that is used to obtain information where no or few data are available. For example, in our experience with a multicountry evaluation of health care resource utilization in atrial fibrillation, very few country-specific published data were available on this subject. Thus the decision-analytic model was supplemented with data from a physician expert panel survey to determine initial management approach (rate control vs. cardioversion) first-, second-, and third-line agents doses and durations of therapy type and frequency of studies that would be performed to initiate and monitor therapy type and frequency of adverse events, by body system and the resources used to manage them place of treatment and adverse consequences of lack of atrial fibrillation control and cost of these consequences, for example, stroke, congestive heart failure. This method may also be used in testing the robustness of the analysis [30]. 

The discovery of the positive inotropic and systemic vasodilator activities of bipyridine-derived compounds, like amrinone (7) and milrinone (8), has markedly stimulated research aimed at the development of structurally related non-steroidal, non-catecholamine cardiotonics. In this context, a wide variety of pyridazinone derivatives have been prepared and investigated in search for novel agents useful for the chronic management of congestive heart failure. 

What system is used to classify heart failure according to severity of symptoms 3a What drug treatment should be initiated for the immediate management of the... 

Levosimendan is a novel inotropic calcium-sensitizing drug. In advanced congestive heart failure, it improves cardiac contractility by sensitizing troponin C to calcium. It has been used recently in a porcine model of endotoxin-induced septic shock, in which pretreatment with levosimendan improved cardiac output and systemic and gut oxygen delivery." There are currently two ongoing clinical trials of levosimendan in septic shock. The role of levosimendan in the supportive management of circulatory failure in sepsis remains to be determined. 

SODIUM NITROPRUSSIDE Sodium nitroprusside (NITROPRESS) is a prodrug and potent vasodilator that reduces both ventricular filling pressures and systemic vascular resistance. It has a rapid onset (2-5 minutes) and offset (quickly metabolized to cyanide and NO, the active vasodilator) of action and its dose can be titrated expeditiously to achieve the desired hemodynamic effect. For these reasons, nitroprusside is commonly used in intensive-care settings for rapid control of severe hypertension and for the management of decompensated heart failure. The basic pharmacologic properties of this drug are described in Chapter 32. 

Patients with diastolic heart failure are typically dependent upon preload to maintain adequate cardiac output. While patients with symptomatic volume overload will benefit from careful modulation of intravascular volume, volume reduction should be accomplished gradually and treatment goals reassessed frequently. In addition to cautious volume management, it is important to maintain synchronous atrial contraction in such patients, which maintains adequate left ventricular filling during the latter phase of diastole. Cardiac function is often severely impaired if patients with diastolic heart failure develop atrial fibrillation, particularly in the context of sub-optimal ventricular rate control. Meticulous control of the ventricular rate with drugs that slow AV conduction is mandatory (see Chapter 34) and restoration of sinus rhythm should be considered. It is also important to evaluate and treat conditions that are associated with dynamic abnormalities of diastolic function, such as myocardial ischemia and poorly controlled systemic hypertension. 

Medical Device Batteries describes wearable and implantable medical devices powered by batteries. Devices include those that are used for cardiac rhythm management (pacemakers, defibrillators, and heart failure devices), hearing loss, bone growth and fusirm, drug delivery for therapy or pain relief, nerve stimulation for pain management, urinary incompetence and nervous system disorders, vision, diagnostic measurements and monitoring, and mechanical heart pumps. 

Villalba E, Salvi D, Ottaviano M, Peinado I, Arredondo MT, and Akay A. Wearable and mobile system to manage remotely heart failure. IEEE Transactions on Information Technology in Biomedicine. 2009 13(6) 990-996. 

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