Management of Patients with Acute Heart Failure

  • W. G. Toller
  • G. Gemes
  • H. Metzler
Part of the Topics in Anaesthesia and Critical Care book series (TIACC)


With an aging population and improved therapeutic strategies in patients with coronary artery disease, hypertension, and diabetes mellitus, the prevalence of patients with chronically impaired myocardial performance is constantly increasing [1]. As a consequence, physicians are also frequently faced with the diagnosis and treatment of a rapid onset of symptoms and signs secondary to abnormal cardiac function. This clinical syndrome of acute heart failure (AHF) in general requires rapid diagnosis and is associated with challenging treatment and a high mortality. Unfortunately, steady improvements in the care of these patients have not been able to change the fact that heart failure is still a major cause of death in the intensive medicine setting. Because of the urgency and challenge of treatment, the number of randomized controlled clinical trials that include these patients is currently low, and therefore empirical rather than evidence-based therapeutic approaches dominate. In 2005, the European Society of Cardiology and the European Society of Intensive Care Medicine published guidelines on the diagnosis and treatment of AHF [2], in which clinical trials are reviewed and treatment algorithms are proposed. In this chapter the recommendations for diagnosis and treatment are summarized and new publications incorporated.


Continuous Positive Airway Pressure Chronic Heart Failure Brain Natriuretic Peptide Acute Heart Failure Centrifugal Pump 
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  1. 1.
    Levy D, Kenchaiah S, Larson, MG et al (2002) Long-term trends in the incidence of and survival with heart failure. N Engl J Med 347:1397–1402PubMedCrossRefGoogle Scholar
  2. 2.
    Nieminen MS, Bohm M, Cowie MR et al (2005) Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J 26:384–416PubMedCrossRefGoogle Scholar
  3. 3.
    Goldberg RJ, Samad NA, Yarzebski J et al (1999) Temporal trends in cardiogenic shock complicating acute myocardial infarction. N Engl J Med 340:1162–1168PubMedCrossRefGoogle Scholar
  4. 4.
    Nohria A, Tsang SW, Fang JC et al (2003) Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol 41:1797–1804PubMedCrossRefGoogle Scholar
  5. 5.
    Maisel AS, McCord J, Nowak RM et al (2003) Bedside B-Type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction. Results from the Breathing Not Properly Multinational Study. J Am Coll Cardiol 41:2010–2017PubMedCrossRefGoogle Scholar
  6. 6.
    Lainchbury JG, Campbell E, Frampton CM et al (2003) Brain natriuretic peptide and N-terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath. J Am Coll Cardiol 42:728–735PubMedCrossRefGoogle Scholar
  7. 7.
    Morrow DA, de Lemos JA, Blazing MA et al (2005) Prognostic value of serial B-type natriuretic peptide testing during follow-up of patients with unstable coronary artery disease. JAMA 294:2866–2871PubMedCrossRefGoogle Scholar
  8. 8.
    Hunt SA (2005) ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 46:81–82CrossRefGoogle Scholar
  9. 9.
    Cheitlin MD, Armstrong WF, Aurigemma GP et al (2003) ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Soc Echocardiogr 16:1091–1110PubMedGoogle Scholar
  10. 10.
    Chittock DR, Dhingra VK, Ronco JJ et al (2004) Severity of illness and risk of death associated with pulmonary artery catheter use. Crit Care Med 32:911–915PubMedCrossRefGoogle Scholar
  11. 11.
    Hochman JS, Sleeper LA, White HD et al (2001) One-year survival following early revascularization for cardiogenic shock. JAMA 285:190–192PubMedCrossRefGoogle Scholar
  12. 12.
    Mebazaa A, Karpati P, Renaud E et al (2004) Acute right ventricular failure-from pathophysiology to new treatments. Intensive Care Med 30:185–196PubMedCrossRefGoogle Scholar
  13. 13.
    Berger MM, Mustafa I (2003) Metabolic and nutritional support in acute cardiac failure. Curr Opin Clin Nutr Metab Care 6:195–201PubMedCrossRefGoogle Scholar
  14. 14.
    Kelly CA, Newby DE, McDonagh TA et al (2002) Randomised controlled trial of continuous positive airway pressure and standard oxygen therapy in acute pulmonary oedema: effects on plasma brain natriuretic peptide concentrations. Eur Heart J 23:1379–1386PubMedCrossRefGoogle Scholar
  15. 15.
    Cotter G, Metzkor E, Kaluski E et al (1998) Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet 351:389–393PubMedCrossRefGoogle Scholar
  16. 16.
    Young JB, Abraham WT, Stevenson LW et al (2002) Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial. JAMA 287:1531–1540CrossRefGoogle Scholar
  17. 17.
    Sackner-Bernstein JD, Skopicki HA, Aaronson, K.D. (2005) Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure. Circulation 111:1487–1491PubMedCrossRefGoogle Scholar
  18. 18.
    Sackner-Bernstein JD, Kowalski M, Fox M et al (2005) Short-term risk of death after treatment with nesiritide for decompensated heart failure: a pooled analysis of randomized controlled trials. JAMA 293:1900–1905PubMedCrossRefGoogle Scholar
  19. 19.
    Topol EJ (2005) Nesiritide-not verified. N Engl J Med 353:113–116PubMedCrossRefGoogle Scholar
  20. 20.
    Thackray S, Easthaugh J, Freemantle N et al (2002) The effectiveness and relative effectiveness of intravenous inotropic drugs acting through the adrenergic pathway in patients with heart failure-a meta-regression analysis. Eur J Heart Fail 4:515–529PubMedCrossRefGoogle Scholar
  21. 21.
    Cuffe MS, Califf RM, Adams KF Jr et al (2002) Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial. JAMA 287:1541–1547PubMedCrossRefGoogle Scholar
  22. 22.
    Felker GM, Benza RL, Chandler AB et al (2003) Heart failure etiology and response to milrinone in decompensated heart failure: results from the OPTIME-CHF study. J Am Coll Cardiol 41:997–1003PubMedCrossRefGoogle Scholar
  23. 23.
    Kaheinen P, Pollesello P, Levijoki J et al (2004) Effects of levosimendan and milrinone on oxygen consumption in isolated guinea-pig heart. J Cardiovasc Pharmacol 43:555–561PubMedCrossRefGoogle Scholar
  24. 24.
    Lilleberg J, Ylonen V, Lehtonen L et al (2004) The calcium sensitizer levosimendan and cardiac arrhythmias: an analysis of the safety database of heart failure treatment studies. Scand Cardiovasc J 38:80–84PubMedCrossRefGoogle Scholar
  25. 25.
    Follath F, Cleland JG, Just H et al (2002) Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomised double-blind trial. Lancet 360:196–202PubMedCrossRefGoogle Scholar
  26. 26.
    Siegenthaler MP, Martin J, Beyersdorf F (2003) Mechanical circulatory assistance for acute and chronic heart failure: a review of current technology and clinical practice. J Interv Cardiol 16:563–572PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • W. G. Toller
    • 1
  • G. Gemes
    • 1
  • H. Metzler
    • 1
  1. 1.Department of Anesthesiology and Intensive Care MedicineMedical University of GrazGrazAustria

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