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Related Concept Videos

Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

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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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Pathophysiology of Heart Failure01:17

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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 I: Introduction01:27

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Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
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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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Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

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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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Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

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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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Author Spotlight: Investigating HR-Dependent Cardiac Function in Mouse Models Through a Novel Atrial-Pacing Approach
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Imatinib for right heart failure in COPD.

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  • 11 Medical University of Graz, Graz, Austria.

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Imatinib offers a new treatment option for severe pulmonary hypertension (PH) in chronic obstructive pulmonary disease (COPD) patients with right heart failure. This tyrosine-kinase inhibitor improved hemodynamics and exercise capacity without significant side effects in a case study.

Keywords:
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Area of Science:

  • Cardiology
  • Pulmonology
  • Pharmacology

Background:

  • Severe pulmonary hypertension (PH) is uncommon in chronic obstructive pulmonary disease (COPD).
  • Standard pulmonary arterial hypertension (PAH) vasodilators are often contraindicated in COPD due to potential severe side effects.
  • Alternative therapies are needed for COPD patients with severe PH and right heart failure.

Observation:

  • A case of severe PH in a COPD patient with right heart failure is presented.
  • The patient did not respond adequately to phosphodiesterase-5 inhibitors or soluble-guanylate-cyclase stimulators alone.
  • Imatinib, a tyrosine-kinase inhibitor, was used as an add-on therapy.

Findings:

  • Imatinib treatment significantly improved hemodynamics, reducing pulmonary vascular resistance from 10.8 WU to 2.9 WU.
  • Biomarkers of heart failure, NT-proBNP, decreased from 4144 pg/mL to 363 pg/mL.
  • Patient's symptoms and exercise capacity improved, with WHO Functional Class changing from IV to III and 6MWD increasing to 303m, with no major adverse events.

Implications:

  • Imatinib, lacking direct vasodilator effects, presents a potential therapeutic option for severe PH in COPD with right heart failure.
  • This finding suggests imatinib may be beneficial in refractory cases where standard therapies have failed.
  • Further investigation into imatinib's role in managing PH secondary to lung disease is warranted.