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Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

512
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...
512
Imbalances in Cardiac Output01:26

Imbalances in Cardiac Output

3.4K
The heart's primary function is to pump blood throughout the body, maintaining a balance between blood sent out (cardiac output) and blood returning (venous return). If this balance is disrupted, it can result in congestive heart failure (CHF), a severe condition where the heart becomes an inefficient pump, leading to inadequate blood circulation.
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
3.4K
Heart Failure VI: Adjunct Therapies01:22

Heart Failure VI: Adjunct Therapies

537
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
537
Heart Failure VII: Nursing Interventions01:30

Heart Failure VII: Nursing Interventions

684
The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
684
Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

4.5K
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
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Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

1.1K
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...
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The role of a distal forearm perforating vein and deep vein system in supporting patency of a snuffbox fistula - A case report.

Journal of vascular surgery cases and innovative techniques·2024
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The challenge of stent placement within cannulation zones of Arteriovenous Fistulae.

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Percutaneous creation of proximal radio-radial arteriovenous hemodialysis fistula before secondary brachial vein elevation.

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Midterm results of percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System, technical recommendations, and an algorithm for maintenance.

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Related Experiment Video

Updated: Mar 24, 2026

Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems
08:49

Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems

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Access flow reduction for cardiac failure.

Pierre Bourquelot1

  • 1Angioaccess Surgery Department, Clinique Jouvenet, Paris - France.

The Journal of Vascular Access
|March 9, 2016
PubMed
Summary

High-flow in hemodialysis access can cause heart failure. Simple techniques like Proximal Radial Artery Ligation (PRAL) and Revision Using Distal Inflow (RUDI) effectively reduce fistula flow, preventing complications.

Area of Science:

  • Vascular Surgery
  • Nephrology
  • Cardiology

Background:

  • High-flow in hemodialysis arteriovenous angioaccesses is a common issue.
  • This can lead to high-output cardiac failure, necessitating fistula flow reduction.
  • Traditional banding techniques for flow reduction have questionable outcomes.

Purpose of the Study:

  • To evaluate the effectiveness of alternative fistula flow reduction techniques.
  • To present personal results for Juxta-anastomosis Proximal Radial Artery Ligation (PRAL) and Revision Using Distal Inflow (RUDI) procedures.

Main Methods:

  • PRAL: A simple technique for side-to-end radio-cephalic fistulas.
  • RUDI-1: Revision Using Distal Inflow using PTFE graft or greater saphenous vein.
  • RUDI-2: Transposition of the Radial Artery procedure.

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Main Results:

  • PRAL achieved a flow reduction rate (RR) of 54% ± 19% in 82 patients.
  • RUDI-1 achieved an RR of 53% ± 18% in 35 patients.
  • RUDI-2 achieved an RR of 66% ± 14% in 47 patients.

Conclusions:

  • PRAL is a simple and effective method for reducing flow in radio-cephalic fistulas.
  • RUDI variants are effective for brachial artery-based fistulas, offering significant flow reduction.
  • These alternative techniques provide viable solutions for managing high-flow hemodialysis access.