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Related Concept Videos

Heart Failure Drugs: β-Blockers01:22

Heart Failure Drugs: β-Blockers

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β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
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Heart Failure VII: Nursing Interventions01:30

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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,...
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Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

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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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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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Heart Failure Drugs: Inotropic Agents01:26

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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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Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

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Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...
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Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy
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Splanchnic Nerve Block for Chronic Heart Failure.

Marat Fudim1, Richard L Boortz-Marx2, Arun Ganesh2

  • 1Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.

JACC. Heart Failure
|June 15, 2020
PubMed
Summary
This summary is machine-generated.

Splanchnic nerve blockade (SNB) significantly reduced cardiac filling pressures during exercise in patients with chronic heart failure (HF). This intervention improved cardiac output and exercise capacity, suggesting potential benefits for HF management.

Keywords:
congestionheart failuresplanchnic nerve blocksympathetic nervous system

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Heart Failure Management

Background:

  • Chronic heart failure (HF) is associated with limited exercise capacity.
  • Excessive cardiac filling pressures during exercise contribute to exercise intolerance in HF patients.

Purpose of the Study:

  • To investigate the effect of splanchnic nerve blockade (SNB) on exercise-induced cardiac filling pressures in patients with chronic HF.
  • To assess the impact of SNB on hemodynamic parameters and exercise capacity.

Main Methods:

  • Prospective, single-arm interventional study involving patients with chronic HF.
  • Invasive hemodynamic assessment during cardiopulmonary exercise testing before and after percutaneous SNB with ropivacaine.
  • Eligible patients had elevated resting or exercise wedge pressures.

Main Results:

  • SNB significantly reduced mean pulmonary arterial pressure and wedge pressure at peak exercise (p < 0.001).
  • Cardiac index increased post-SNB (p = 0.011).
  • Patients demonstrated increased workload (p = 0.019) and peak oxygen consumption (p = 0.053) after SNB.

Conclusions:

  • SNB effectively reduces resting and exercise-induced pulmonary and wedge pressures in chronic HF.
  • The procedure shows favorable effects on cardiac output and exercise capacity.
  • Further research into the short- and long-term effects of SNB in chronic HF is warranted.