Journal article
Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance.
- Mebazaa A U 942 Inserm, Paris, France. alexandre.mebazaa@aphp.fr.
- Tolppanen H U 942 Inserm, Paris, France.
- Mueller C Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
- Lassus J Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
- DiSomma S Department of Medical Sciences and Translational Medicine, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.
- Baksyte G Department of Cardiology, Kaunas University of Medicine, Kaunas, Lithuania.
- Cecconi M Anaesthesia and Intensive Care, St George's Hospital and Medical School, London, SW17 0QT, UK.
- Choi DJ Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
- Cohen Solal A U 942 Inserm, Paris, France.
- Christ M Department of Emergency and Intensive Care Medicine, Paracelsus Medical University, Nuremberg, Germany.
- Masip J Department of Intensive Care Medicine, Consorci Sanitari Integral, University of Barcelona, Barcelona, Spain.
- Arrigo M U 942 Inserm, Paris, France.
- Nouira S Emergency Department and Research Unit UR06SP21, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
- Ojji D Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.
- Peacock F Department of Emergency Medicine, Baylor College of Medicine, Boston, MA, USA.
- Richards M Christchurch Cardioendocrine Research Group, Christchurch Hospital, Christchurch, New Zealand.
- Sato N Internal Medicine, Cardiology, and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan.
- Sliwa K Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa and IIDMM, University of Cape Town, Cape Town, South Africa.
- Spinar J Department of Cardiovascular Disease, International Clinical Research Center, University Hospital Brno, Brno, Czech Republic.
- Thiele H Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Centre Luebeck, University Hospital Schleswig-Holstein, Lübeck, Germany.
- Yilmaz MB Department of Cardiology, Cumhuriyet University School of Medicine, Sivas, Turkey.
- Januzzi J Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA.
- 2015-09-16
Published in:
- Intensive care medicine. - 2016
Cardiogenic shock
Emergency
Heart failure
Treatment
Acute Disease
Critical Care
Heart Failure
Humans
Practice Guidelines as Topic
Shock, Cardiogenic
English
PURPOSE
Acute heart failure (AHF) causes high burden of mortality, morbidity, and repeated hospitalizations worldwide. This guidance paper describes the tailored treatment approaches of different clinical scenarios of AHF and CS, focusing on the needs of professionals working in intensive care settings.
RESULTS
Tissue congestion and hypoperfusion are the two leading mechanisms of end-organ injury and dysfunction, which are associated with worse outcome in AHF. Diagnosis of AHF is based on clinical assessment, measurement of natriuretic peptides, and imaging modalities. Simultaneously, emphasis should be given in rapidly identifying the underlying trigger of AHF and assessing severity of AHF, as well as in recognizing end-organ injuries. Early initiation of effective treatment is associated with superior outcomes. Oxygen, diuretics, and vasodilators are the key therapies for the initial treatment of AHF. In case of respiratory distress, non-invasive ventilation with pressure support should be promptly started. In patients with severe forms of AHF with cardiogenic shock (CS), inotropes are recommended to achieve hemodynamic stability and restore tissue perfusion. In refractory CS, when hemodynamic stabilization is not achieved, the use of mechanical support with assist devices should be considered early, before the development of irreversible end-organ injuries.
CONCLUSION
A multidisciplinary approach along the entire patient journey from pre-hospital care to hospital discharge is needed to ensure early recognition, risk stratification, and the benefit of available therapies. Medical management should be planned according to the underlying mechanisms of various clinical scenarios of AHF.
Acute heart failure (AHF) causes high burden of mortality, morbidity, and repeated hospitalizations worldwide. This guidance paper describes the tailored treatment approaches of different clinical scenarios of AHF and CS, focusing on the needs of professionals working in intensive care settings.
RESULTS
Tissue congestion and hypoperfusion are the two leading mechanisms of end-organ injury and dysfunction, which are associated with worse outcome in AHF. Diagnosis of AHF is based on clinical assessment, measurement of natriuretic peptides, and imaging modalities. Simultaneously, emphasis should be given in rapidly identifying the underlying trigger of AHF and assessing severity of AHF, as well as in recognizing end-organ injuries. Early initiation of effective treatment is associated with superior outcomes. Oxygen, diuretics, and vasodilators are the key therapies for the initial treatment of AHF. In case of respiratory distress, non-invasive ventilation with pressure support should be promptly started. In patients with severe forms of AHF with cardiogenic shock (CS), inotropes are recommended to achieve hemodynamic stability and restore tissue perfusion. In refractory CS, when hemodynamic stabilization is not achieved, the use of mechanical support with assist devices should be considered early, before the development of irreversible end-organ injuries.
CONCLUSION
A multidisciplinary approach along the entire patient journey from pre-hospital care to hospital discharge is needed to ensure early recognition, risk stratification, and the benefit of available therapies. Medical management should be planned according to the underlying mechanisms of various clinical scenarios of AHF.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1007/s00134-015-4041-5
- PMID 26370690
- Persistent URL
- https://fredi.hepvs.ch/global/documents/92081
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