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Related Concept Videos

Heart Failure VI: Adjunct Therapies01:22

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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.
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Cardiomyopathy II: Dilated Cardiomyopathy01:30

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Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
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Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
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Heart Failure V: Medical Management01:30

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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...
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Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
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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...
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A Fully Magnetically Levitated Circulatory Pump for Advanced Heart Failure.

Mandeep R Mehra1, Yoshifumi Naka1, Nir Uriel1

  • 1From the Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston (M.R.M.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital (Y.N., P.C.C.) and Montefiore Einstein Center for Heart and Vascular Care (D.J.G., U.P.J.) - all in New York; University of Chicago School of Medicine and Medical Center, Chicago (N.U.); University of Colorado School of Medicine, Denver (J.C.C.); St. Vincent Heart Center, Indianapolis (M.N.W., C.S.); Duke Heart Center, Duke University, Durham, NC (C.A.M., C.B.P.); University of Michigan Health System, Ann Arbor (F.D.P., K.D.A.); Piedmont Hospital, Atlanta (D.A.D., K.M.); Washington University School of Medicine, St. Louis (A.I., G.A.E.); and Integris Baptist Medical Center, Oklahoma City (D.H., J.W.L.).

The New England Journal of Medicine
|December 14, 2016
PubMed
Summary

A new centrifugal-flow pump significantly improved survival outcomes for advanced heart failure patients compared to axial-flow pumps. This new device reduced reoperations and eliminated pump thrombosis, enhancing patient survival rates.

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Area of Science:

  • Cardiovascular Medicine
  • Biomedical Engineering
  • Medical Devices

Background:

  • Continuous-flow left ventricular assist systems (CF-LVAS) improve survival in advanced heart failure.
  • Pump thrombosis is a significant complication associated with current CF-LVAS.
  • A novel magnetically levitated centrifugal-flow pump was developed to mitigate thrombosis.

Purpose of the Study:

  • To compare the efficacy and safety of a new centrifugal-flow pump versus an axial-flow pump in patients with advanced heart failure.
  • To evaluate the primary endpoint of survival free of disabling stroke or reoperation at 6 months.
  • To assess the incidence of pump thrombosis and reoperation rates between the two device types.

Main Methods:

  • A randomized trial comparing a centrifugal-flow pump against a commercially available axial-flow pump.
  • Patients with advanced heart failure were enrolled regardless of support goal (bridge to transplant or destination therapy).
  • The primary endpoint was a composite of survival free of disabling stroke or reoperation at 6 months post-implantation.

Main Results:

  • The centrifugal-flow pump group demonstrated a higher rate of the primary endpoint (86.2%) compared to the axial-flow group (76.8%), achieving noninferiority and superiority.
  • Reoperation for pump malfunction was significantly lower in the centrifugal-flow pump group (0.7% vs. 7.7%).
  • Pump thrombosis occurred in 0% of patients with the centrifugal-flow pump, versus 10.1% in the axial-flow pump group.

Conclusions:

  • The fully magnetically levitated centrifugal-flow pump showed improved outcomes at 6 months compared to the axial-flow pump in advanced heart failure patients.
  • The primary benefit was attributed to a substantially lower rate of reoperation for pump malfunction.
  • The novel centrifugal-flow pump effectively eliminated pump thrombosis in this study cohort.