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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

Pathophysiology of Heart Failure

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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

Heart Failure I: Introduction

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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

Heart Failure VI: Adjunct Therapies

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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.
277
Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

824
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

227
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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Related Experiment Video

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Author Spotlight: Investigating HR-Dependent Cardiac Function in Mouse Models Through a Novel Atrial-Pacing Approach
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Relationship between invasive hemodynamics and liver function in advanced heart failure.

Julie K K Vishram-Nielsen1, Tania Deis1, Louise Balling1

  • 1Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark.

Scandinavian Cardiovascular Journal : SCJ
|July 23, 2019
PubMed
Summary

In advanced heart failure patients, central venous pressure (CVP) correlates with liver function markers. Improving CVP through decongestion may enhance liver function in these patients.

Keywords:
advanced heart failurehemodynamicsliver functionright heart catheterizationright ventricular failurevolume overload

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Area of Science:

  • Cardiology
  • Hepatology
  • Internal Medicine

Background:

  • Advanced heart failure (AHF) significantly impacts multiple organ systems, including the liver.
  • Understanding the relationship between liver function (LF) and hemodynamics is crucial for managing AHF patients.
  • Optimizing medical therapy is key in AHF, but its effect on liver function requires further investigation.

Purpose of the Study:

  • To investigate the cross-sectional and longitudinal associations between liver function tests and invasive hemodynamic parameters in AHF patients.
  • To determine if interventions aimed at improving hemodynamics, such as decongestion, can positively influence liver function in AHF.

Main Methods:

  • Retrospective analysis of 309 AHF patients (left ventricular ejection fraction < 45%) undergoing right heart catheterization (RHC).
  • Hemodynamic measurements included pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), cardiac index (CI), and mean arterial pressure (MAP).
  • Liver function was assessed via plasma alanine transaminase (ALT), alkaline phosphatase (ALP), bilirubin, albumin, lactate dehydrogenase, and prothrombin time/International Normalized Ratio (PT/INR). RHC and LF were repeated in 33 patients.

Main Results:

  • Central venous pressure (CVP) showed significant associations with alkaline phosphatase (ALP), bilirubin, and international normalized ratio (INR).
  • Pulmonary capillary wedge pressure (PCWP) and cardiac index (CI) were associated with bilirubin levels.
  • Longitudinal analysis revealed that changes in CVP positively correlated with changes in bilirubin, a marker of biliary excretion.

Conclusions:

  • In optimally treated AHF patients, CVP is linked to both biliary excretion and liver synthesis markers.
  • Changes in CVP over time are associated with alterations in markers of biliary excretion.
  • Decongestion strategies may offer a therapeutic benefit by improving liver function in advanced heart failure.