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Related Concept Videos

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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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...
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Nursing management is essential for preventing complications, maintaining stability, and improving patients' quality of life in chronic kidney disease (CKD). By using a structured approach, nurses help slow CKD progression and support effective patient care​.1. Comprehensive patient assessmentEffective management begins with nurses reviewing the patient’s medical history, and identifying key risk factors like diabetes, hypertension, and nephrotoxic drug use. Nurses assess signs of...
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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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Assessment: Nursing management of patients with cardiomyopathy begins with a thorough assessment of the patient's history, including a family history of cardiomyopathy or sudden cardiac death, personal history of heart disease, hypertension, diabetes, and any alcohol consumption or drug use.During the physical examination, assess vital signs, look for signs of heart failure (such as edema, jugular venous distention, and cyanosis), auscultate for abnormal heart sounds (like murmurs and gallops),...
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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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Worsening Renal Function in Cardiac Mechanical Support.

Julie Tsay1, Daniel Pinkhas1, Bryan C Lee2

  • 1Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA.

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|February 24, 2020
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Worsening renal failure (WRF) after left ventricular assist device (LVAD) implantation is linked to higher mortality and increased need for dialysis. High central venous pressure (CVP) is a key risk factor for WRF in these patients.

Keywords:
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Area of Science:

  • Cardiology
  • Nephrology
  • Mechanical Circulatory Support

Background:

  • Venous congestion in heart failure (HF) can precipitate worsening renal failure (WRF).
  • Limited data exists on WRF in HF patients with mechanical support, specifically left ventricular assist devices (LVADs).
  • This study investigates the association between WRF and 1-year mortality in LVAD recipients.

Purpose of the Study:

  • To determine if WRF in patients hospitalized for LVAD implantation correlates with increased 1-year mortality.
  • To identify risk factors contributing to WRF in this patient population.

Main Methods:

  • Retrospective chart analysis of 162 patients undergoing LVAD implantation (August 2006 - December 2014).
  • Inclusion of pre-LVAD right heart catheterization data.
  • Stratification based on WRF and use of hemodialysis (HD) or ultrafiltration (UF).

Main Results:

  • Higher central venous pressure (CVP) >16 mmHg was associated with WRF development (29.7% vs. 14.1%, p=0.019).
  • A CVP ≥16 mmHg and glomerular filtration rate (GFR) <30 ml/min/1.74m² increased WRF odds.
  • WRF and HD/UF use correlated with increased 1-year mortality.
  • GFR <30 ml/min/1.74m², atherosclerosis, and right ventricular failure independently predicted 1-year mortality.
  • GFR <30 ml/min/1.74m² increased WRF odds five-fold (OR 4.14).

Conclusions:

  • WRF in LVAD patients is linked to elevated CVP during implantation.
  • WRF significantly increases 1-year mortality risk and the likelihood of requiring HD/UF.
  • Thorough renal function and comorbidity assessment pre-LVAD implantation is crucial for risk stratification and mortality reduction.