Related Experiment Videos
Levosimendan: a retrospective single-center case series
William T Berry1, Russell W Hewson, Chris J Langrish
1Institute of Pharmaceutical Sciences, Kings College London, London SE1 9RT, United Kingdom; Pharmacy and Critical Care, Guy's and St. Thomas' Foundation Hospital, London SE1 7EH, United Kingdom.
Journal of Critical Care
|September 4, 2013
Summary
Levosimendan without a loading dose improved cardiac function and perfusion in acute heart failure patients. This treatment reduced the need for inotropes and vasopressors, with a 53% survival rate.
Area of Science:
- Cardiology
- Pharmacology
- Intensive Care Medicine
Background:
- Acute heart failure (AHF) is a critical condition requiring immediate hemodynamic support.
- Inotropes and vasopressors are standard treatments but can have significant side effects.
- Levosimendan is a calcium sensitizer and vasodilator used in heart failure management.
Purpose of the Study:
- To evaluate the effects of levosimendan, administered without a loading dose, on hemodynamic parameters, vasopressor/inotrope use, and mortality in patients with AHF.
- To assess the impact of this levosimendan regimen on key perfusion markers.
Main Methods:
- Retrospective analysis of 87 patients with AHF treated with levosimendan (without loading dose).
- Collection of hemodynamic data, inotrope/vasopressor requirements, and fluid balance at baseline, end of infusion, and 24 hours post-infusion.
- Monitoring of mortality rates.
Main Results:
- A mean levosimendan dose of 0.096 μg/kg/min was administered for a mean duration of 26 hours.
- No significant changes in heart rate or mean arterial pressure were observed.
- Significant reductions in dobutamine and noradrenaline requirements were noted.
- Improvements in cardiac index, base excess, and lactate levels indicated enhanced perfusion.
- Survival rate was 53%.
Conclusions:
- Levosimendan, when administered without a loading dose, effectively improves cardiac index and perfusion in AHF patients.
- This regimen allows for a reduction in the reliance on other inotropic and vasopressor agents.
- The findings suggest a potential role for levosimendan as a less intensive option in AHF management.
Related Concept Videos
01:26Heart Failure Drugs: Inotropic Agents
Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
01:22Heart Failure Drugs: Diuretics
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
01:26Heart Failure III: Clinical Manifestations
Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...
01:30Heart Failure V: Medical Management
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
01:22Heart Failure Drugs: β-Blockers
β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation, vasodilation, and...
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...