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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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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 Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

636
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

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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A Surgical Model of Heart Failure with Preserved Ejection Fraction in Tibetan Minipigs
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Renal Dysfunction and Heart Failure with Preserved Ejection Fraction.

Manjula G Ananthram1, Stephen S Gottlieb1

  • 1Department of Internal Medicine, Division of Cardiology, University of Maryland, 110 South Paca Street, 7th Floor, Baltimore, MD 21201, USA.

Heart Failure Clinics
|May 30, 2021
PubMed
Summary

Heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD) share a high-risk profile. Understanding their complex interplay is key to developing targeted therapies for HFpEF.

Keywords:
CKDCardiorenal syndromeHFpEFHeart failure with preserved ejection fractionRenal dysfunctionRenal impairment

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Area of Science:

  • Cardiology
  • Nephrology
  • Internal Medicine

Background:

  • Heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD) often coexist, creating a high-risk patient group with poor prognosis.
  • Pro-inflammatory conditions significantly contribute to the development of both HFpEF and CKD.
  • Renal dysfunction in HFpEF arises from a complex interaction of hemodynamic, inflammatory, and neurohormonal factors.

Purpose of the Study:

  • To highlight the significant morbidity and mortality associated with the HFpEF and CKD phenotype.
  • To emphasize the lack of effective targeted therapies for HFpEF compared to heart failure with reduced ejection fraction.
  • To advocate for phenotype-specific research and development of targeted pharmaceutical therapies.

Main Methods:

  • Review of existing literature on the pathophysiology of HFpEF and CKD.
  • Analysis of the interplay between hemodynamic factors, systemic congestion, inflammation, endothelial dysfunction, and neurohormonal mechanisms in renal dysfunction within HFpEF.
  • Comparative analysis of therapeutic strategies for HFpEF versus heart failure with reduced ejection fraction.

Main Results:

  • HFpEF and CKD represent a challenging clinical phenotype due to shared underlying pathophysiological mechanisms.
  • Systemic inflammation and endothelial dysfunction are critical drivers in the progression of both conditions.
  • Current therapeutic options for HFpEF are limited, necessitating further research.

Conclusions:

  • Developing effective, phenotype-specific therapies for HFpEF requires a deeper understanding of its intricate pathophysiology.
  • Tailoring study designs to specific HFpEF phenotypes may accelerate the discovery of novel pharmaceutical treatments.
  • Addressing the complex interplay of comorbid conditions is crucial for improving outcomes in patients with HFpEF and CKD.