ISSN 2398-2969      

Acute heart failure

icanis

Synonym(s): Decompensated heart failure; acute decompensation


Introduction

  • Although many patients suffering from cardiovascular disease are identified during routine examination or present with mild clinical signs, a subset will present on an emergency basis with severe, life-threatening congestive heart failure.
  • These patients often require aggressive therapy and intensive monitoring to achieve a successful outcome.
  • Despite their critical status at presentation many will survive for prolonged periods if the acute episode is successfully managed.

Pathogenesis

Etiology

  • Etiologies behind development of CDVD and DCM are not totally understood (genetic component plays a role, eg Cavalier King Charles Spaniels Cavalier King Charles Spaniel with CDVD).
  • Ruptured chordae tendinae Heart: rupture of chordae tendinae.
  • Some dogs, predominately American Cocker Spaniels American Cocker Spaniel , have been recognized to have taurine responsive dilated cardiomyopathy Acute heart failure: taurine supplementation.
  • Stressful events (eg provoking cardiogenic shock Shock and decompensation in a patient with DCM).

Pathophysiology

  • Following the initial cardiac insult (induction of CDVD or DCM) and a reduction in cardiac output there are short-term compensatory mechanisms that become activated to facilitate circulatory homeostasis, including:
    • Sympathetic nervous system.
    • Renin-angiotensin-aldosterone system (RAAS).
    • Release of arginine-vasopressin.
    • Renal sodium and water retention.
    • Increased preload optimizing Frank-Starling mechanism in an attempt to increase stroke volume.
  • The heart's ability to hypertrophy, eccentrically in the face of volume overload and concentrically in the face of pressure overload, normalizes the cardiac output and serves as long-term compensatory mechanism.
  • Unfortunately cardiovascular disease in dogs is mostly progressive and in some instances the heart's capacity to hypertrophy is overwhelmed.
  • This results in decline of cardiac output and reactivation of short-term compensatory mechanisms.
  • Instead of augmenting the heart's capacity to deliver blood, the short-term compensatory mechanisms now prove deleterious by further increasing preload and afterload.
  • Ultimately pulmonary capillary pressures rise promoting the development of pulmonary edema Lung: pulmonary edema while pronounced increase in afterload diminishes effective forward blood and increases myocardial oxygen demands.

Timecourse

  • Time until development of decompensated heart failure is difficult to predict based on today's diagnostic modalities.
  • Some patients live for years with significant cardiovascular disease but never develop nor require treatment for heart failure.
  • Recognized predisposing factors that may quickly shift a patient with compensated heart failure to a decompensated state include:

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Papeles arbitrados

  • Recent references from PubMed and VetMedResource.
  • Boswood A, Attree S & Page K (2003) Clinical validation of a proANP 31-67 fragment ELISA in the diagnosis of heart failure in the dog. J Small Anim Pract 44 (3), 104-108 PubMed.
  • Greco D S, Biller B & Van Liew C H (2003) Measurement of plasma atrial natriuretic peptide as an indicator of prognosis in dogs with cardiac disease. Can Vet J 44 (4), 293-297 PubMed.
  • Capomolla S, Pozzoli M, Opasich C, Febo O, Riccardi G, Salvucci F et al (1997) Dobutamine and nitroprusside infusion in patients with severe congestive heart failure: hemodynamic improvement by discordant effects on mitral regurgitation, left atrial function, and ventricular function. Am Heart J 134 (6), 1089-1098 PubMed.
  • Tidolm A, Svensson H & Sylven C (1997) Survival and prognostic factors in 189 dogs with dilated cardiomyopathy. J Am Anim Hosp Assoc 33 (4), 364-368 PubMed.
  • Monnet E, Orton E C, Salman M & Boon J (1995) Idiopathic dilated cardiomyopathy in dogs: survival and prognostic indicators.  Vet Intern Med (1), 12-17 PubMed.

Otras fuentes de información

  • Small Animal Formulary (2002) Bryn Tennant. 4th Edn BSAVA. pp 211-212.
  • Kittleson M (2000) Therapy of heart failure. In: Textbook of Veterinary Internal Medicine.5th edn. Ed S J F E Ettinger. Philadelphia: WB Saunders Company. pp 713-737.
  • Sisson D & Kittleson M (1999) Management of Heart Failure: Principles of Treatment, Therapeutic Strategies, and Pharmacology. In: Textbook of Canine and Feline Cardiology: Principles and Clinical Practice.2nd edn. Eds P R Fox, D Sisson and N S Moise. Philadelphia: WB Saunders. pp 216-250.

 

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