Acute decompensated heart failure

Lepage, Serge

doi:10.1016/s0828-282x(08)71022-5

Cited by 15 publications

(9 citation statements)

References 8 publications

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“…Because of these modulations in the baroreflex characteristics, the AP regulation was less robust against exogenous disturbances in CHF (Fig. 5), which may partly explain the incidence of acute decompensation in stable CHF patients caused by noncompliance with salt and water restriction [19].…”

Section: Discussionmentioning

confidence: 99%

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Open-loop dynamic and static characteristics of the carotid sinus baroreflex in rats with chronic heart failure after myocardial infarction

Kawada

Kamiya

et al. 2010

J Physiol Sci

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We estimated open-loop dynamic characteristics of the carotid sinus baroreflex in normal control rats and chronic heart failure (CHF) rats after myocardial infarction. First, the neural arc transfer function from carotid sinus pressure to splanchnic sympathetic nerve activity (SNA) and its corresponding step response were examined. Although the steady-state response was attenuated in CHF, the negative peak response and the time to peak did not change significantly, suggesting preserved neural arc dynamic characteristics. Next, the peripheral arc transfer function from SNA to arterial pressure (AP) and its corresponding step response were examined. The steady-state response and the initial slope were reduced in CHF, suggesting impaired end-organ responses. In a simulation study based on the dynamic and static characteristics, the percent recovery of AP was reduced progressively as the size of disturbance increased in CHF, suggesting that a reserve for AP buffering is lost in CHF despite relatively maintained baseline AP.

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Section: Discussionmentioning

confidence: 99%

“…The exogenous disturbance in the opposite direction may also be hazardous. Even though baseline AP appears normal in stable CHF patients, noncompliance with salt and water restriction may easily collapse the AP regulation and induce acute decompensation [19].…”

Section: Equilibrium Diagram and Simulation Studymentioning

confidence: 99%

Open-loop dynamic and static characteristics of the carotid sinus baroreflex in rats with chronic heart failure after myocardial infarction

Kawada

Kamiya

et al. 2010

J Physiol Sci

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“…Heart failure is a leading cause of hospitalization in individuals over the age of 65 with most patients presenting with dyspnea from pulmonary congestion and poor perfusion (Lewin et al, 2005; Lepage, 2008). Despite advanced treatments, many HF patients are re-admitted to hospitals, with a rate that approaches 25% within the first thirty days of original admission (Cleland et al, 2003; Ross et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Influence of lung volume, fluid and capillary recruitment during positional changes and exercise on thoracic impedance in heart failure

Kim

Fuglestad

Richert

et al. 2014

Respiratory Physiology & Neurobiology

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It is unclear how dynamic changes in pulmonary-capillary blood volume (Vc), alveolar lung volume (derived from end-inspiratory lung volume, EILV) and interstitial fluid (ratio of alveolar capillary membrane conductance and pulmonary capillary blood volume, Dm/Vc) influence lung impedance (ZT). The purpose of this study was to investigate if positional change and exercise result in increased EILV, Vc and/or lung interstitial fluid, and if ZT tracks these variables. Methods 12 heart failure (HF) patients underwent measurements (ZT, EILV, Vc/Dm) at rest in the upright and supine positions, during exercise and into recovery. Inspiratory capacity was obtained to provide consistent measures of EILV while assessing ZT. Results ZT increased with lung volume during slow vital capacity maneuvers (p<0.05). Positional change (upright→supine) resulted in an increased ZT (p<0.01), while Vc increased and EILV and Dm/Vc decreased (p<0.05). Moreover, during exercise Vc and EILV increased and Dm/Vc decreased (p<0.05), whereas, ZT did not change significantly (p>0.05). Conclusion Impedance appears sensitive to changes in lung volume and body position which appear to generally overwhelm small acute changes in lung fluid when assed dynamically at rest or during exercise.

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“…Acute decompensated heart failure is the most common reason that individuals over the age of 65 in Canada are admitted to hospital. 12 More than 30% of these patients have a normal or near normal ejection fraction. 13 There is emerging evidence that diastolic dysfunction diagnosed prior to surgery is associated with increased morbidity and mortality.…”

mentioning

confidence: 99%

“…Au Canada, l'insuffisance cardiaque décompensée aiguë constitue la raison numéro un d'admission à l'hôpital de patients âgés de plus de 65 ans. 12 Plus de 30 % des patients admis présentent une fraction d'éjection normale ou quasi normale. 13 De nouvelles données probantes suggèrent qu'une dysfonction diastolique détectée avant la chirurgie est associée à une morbidité et une mortalité accrues.…”

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What about the other two-thirds of the cardiac cycle?

Finegan

2009

Can J Anesth/J Can Anesth

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Diastolic dysfunction is a relatively new clinical diagnosis being made in patients where the observed echocardiographic findings are deemed to be consistent with abnormalities of left ventricular (LV) filling. Left ventricular filling is dependent on the complex interaction of three processes: LV relaxation, LV compliance, and left atrial (LA) contraction. 1 Left ventricular relaxation is an active process involving the uptake of Ca ?? into the sarcoplasmic reticulum by the sarcoendoplasmic reticulum Ca ?? ATPase pump and removal of Ca ?? from the cell by way of the sodium-calcium exchanger. Sarcoendoplasmic reticulum Ca ?? ATPase pump expression and activity is reduced in the cardiomyocyte (and diastolic function is altered) with the onset of senescence, hypertrophy, and heart failure. Left ventricular compliance is a measure of the relationship between LV volume and LV pressure development during LV filling (dV/dp). Left ventricular compliance is influenced by: 1) the presence of ventricular hypertrophy; 2) the functional state of the right ventricle (direct diastolic ventricular interaction), since both ventricles share the septum as a common wall; and 3) the properties of the pericardium. 2 Abnormal LV compliance is a feature of longstanding poorly-controlled hypertension, 3 right ventricular dysfunction, 4 and pericardial disease. 2 In the presence of abnormal LV relaxation and/or compliance, LA contraction assumes a key role in maintaining LV filling. Under physiological conditions in youthful individuals, atrial contraction contributes approximately 20% of the total filling volume of the LV; whereas, in patients with LV diastolic dysfunction, LA contraction may account for over 50% of LV volume at enddiastole. 1 Absence of LA contraction, as occurs with the development of atrial fibrillation, is a harbinger of heart failure and is a marker of an increased risk of premature death. 5 The occurrence of abnormal LV relaxation and compliance, as a consequence of hypertensive heart disease, is one of the most common determinants of LA enlargement, poor LA contractile function, and LA dysrhythmia development. 6

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Acute decompensated heart failure

Cited by 15 publications

References 8 publications

Open-loop dynamic and static characteristics of the carotid sinus baroreflex in rats with chronic heart failure after myocardial infarction

Open-loop dynamic and static characteristics of the carotid sinus baroreflex in rats with chronic heart failure after myocardial infarction

Influence of lung volume, fluid and capillary recruitment during positional changes and exercise on thoracic impedance in heart failure

What about the other two-thirds of the cardiac cycle?

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