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Related Concept Videos

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

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

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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 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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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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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.
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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 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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Related Experiment Video

Updated: Aug 31, 2025

The Muscle Cuff Regenerative Peripheral Nerve Interface for the Amplification of Intact Peripheral Nerve Signals
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Neuromodulation devices for heart failure.

Veronica Dusi1, Filippo Angelini1, Michael R Zile2

  • 1Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10126 Turin, Italy.

European Heart Journal Supplements : Journal of the European Society of Cardiology
|August 22, 2022
PubMed
Summary

Device-based neuromodulation, including cervical vagal nerve stimulation, baroreflex activation therapy, and spinal cord stimulation, shows promise for treating chronic heart failure with reduced ejection fraction by targeting autonomic imbalance.

Keywords:
Autonomic imbalanceAutonomic regulation therapyDevice-therapyNeuromodulationSympathetic nervous system

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Area of Science:

  • Cardiology
  • Neuroscience
  • Biomedical Engineering

Background:

  • Autonomic imbalance, particularly sympathetic dominance, significantly contributes to the pathophysiology of heart failure with reduced ejection fraction (HFrEF).
  • Neuromodulation strategies targeting the cardiac autonomic nervous system are emerging as potential therapeutic interventions for HFrEF.

Purpose of the Study:

  • This review focuses on device-based neuromodulation techniques for managing HFrEF.
  • It aims to discuss general principles of electrical neuromodulation, dose-response relationships, and specific device-based therapies.

Main Methods:

  • The review summarizes the rationale, pre-clinical data, and clinical evidence for three primary device-based neuromodulation approaches in HFrEF.
  • These include cervical vagal nerve stimulation (cVNS), baroreflex activation therapy (BAT), and spinal cord stimulation (SCS).

Main Results:

  • Baroreflex activation therapy (BAT) is FDA-approved for HFrEF patients.
  • Cervical vagal nerve stimulation (cVNS) and spinal cord stimulation (SCS) are still investigational but are under active clinical investigation, with cVNS in a large Phase III study.

Conclusions:

  • Device-based neuromodulation represents a promising therapeutic avenue for HFrEF by addressing autonomic dysfunction.
  • Further research and clinical trials are ongoing to establish the efficacy and safety of these investigational approaches.