Sumário de atualização da II Diretriz Brasileira de Insuficiência Cardíaca Aguda 2009/2011

Abstract

In the past two years we observed several changes in the diagnostic and therapeutic approach of patients with acute heart failure (acute HF), which led us to the need of performing a summary update of the II Brazilian Guidelines on Acute Heart Failure 2009.In the diagnostic evaluation, the diagnostic flowchart was simplified and the role of clinical assessment and echocardiography was enhanced. In the clinicalhemodynamic evaluation on admission, the hemodynamic echocardiography gained prominence as an aid to define this condition in patients with acute HF in the emergency room. In the prognostic evaluation, the role of biomarkers was better established and the criteria and prognostic value of the cardiorenal syndrome was better defined.The therapeutic approach flowcharts were revised, and are now simpler and more objective. Among the advances in drug therapy, the safety and importance of the maintenance or introduction of beta-blockers in the admission treatment are highlighted. Anticoagulation, according to new evidence, gained a wider range of indications. The presentation hemodynamic models of acute pulmonary edema were well established, with their different therapeutic approaches, as well as new levels of indication and evidence. In the surgical treatment of acute HF, CABG, the approach to mechanical lesions and heart transplantation were reviewed and updated.This update strengthens the II Brazilian Guidelines on Acute Heart Failure to keep it updated and refreshed. All clinical cardiologists who deal with patients with acute HF will find, in the guidelines and its summary, important tools to help them with the clinical practice for better diagnosis and treatment of their patients.

Ações de autocuidado em portadores de insuficiência cardíaca

“…Compared to a previous study, (10) the total score for treatment adherence remained within the mean values. The fact that no difference was found in the scores for adherence to treatment and self-care be-verity factors, including hemodynamic profile with predominant pulmonary congestion, followed by low cardiac output related to prolonged hospitalization and high mortality in this group.…”

“…Profile C: Congested patients with low output; 4. Profile L: Patients without signs of congestion with low output; (10) noninvasive monitoring; treatment and outcomes that included length of hospitalization, transfer, discharge and death.…”

2 nd Brazilian Consensus on Chagas Disease, 2015

“…Positive inotropic drugs (such as catecholamine or milrinone) have limited applicability in intensive care settings, and slightly prolonged cardiac decompensation. Digitalis, however, may be administered chronically in individuals without bradyarrhythmias to alleviate their symptoms and prevent cardiac decompensation and hospital admission, especially in patients with atrial fibrillation with rapid ventricular response (255) .…”

Uso da monitorização hemodinâmica contínua não invasiva na insuficiência cardíaca descompensada

“…Although the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE Trial) study did not demonstrate 14 alterations in mortality with the catheter use, the Brazilian guidelines indicate the procedure for managing difficult cases or when there are questions that can be resolved by hemodynamic evaluation 15 .…”