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Related Concept Videos

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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Imbalances in Cardiac Output01:26

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The heart's primary function is to pump blood throughout the body, maintaining a balance between blood sent out (cardiac output) and blood returning (venous return). If this balance is disrupted, it can result in congestive heart failure (CHF), a severe condition where the heart becomes an inefficient pump, leading to inadequate blood circulation.
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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 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 Drugs: Diuretics01:22

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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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Author Spotlight: Exploring the Relationship Between Lipotoxicity and HFpEF
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Light-Chain (AL) Cardiac Amyloidosis Presenting as Heart Failure With Reduced Ejection Fraction.

Luis E Santiago1,2, Ali Tariq Alvi1,2, Veniamin Melnychuk1,2

  • 1Internal Medicine, HCA Florida Northwest Hospital, Margate, USA.

Cureus
|April 1, 2024
PubMed
Summary

Systemic amyloidosis, a protein misfolding disease, can cause heart failure. This case highlights a rare presentation of heart failure with reduced ejection fraction as an initial symptom.

Keywords:
cardiac amyloidosiscardiac amyloidosis with reduced ejection fractiondiastolic heart failureimmunoglobulin light-chain amyloidosisttr cardiac amyloidosis

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Area of Science:

  • Cardiology
  • Nephrology
  • Oncology

Background:

  • Systemic amyloidosis involves extracellular protein misfolding, leading to organ dysfunction.
  • Common subtypes are light-chain amyloidosis and transthyretin amyloidosis.
  • Cardiac involvement often causes restrictive cardiomyopathy and heart failure with preserved ejection fraction.

Observation:

  • A 53-year-old female presented with new-onset heart failure.
  • The patient exhibited heart failure with reduced ejection fraction and diastolic dysfunction.
  • No prior diagnosis or symptoms of amyloidosis were noted.

Findings:

  • This case presents an atypical initial manifestation of systemic amyloidosis.
  • Heart failure with reduced ejection fraction can be an early sign, contrary to typical presentations.
  • Diastolic dysfunction was also observed in this patient.

Implications:

  • Highlights the importance of considering amyloidosis in unexplained heart failure, even with reduced ejection fraction.
  • Suggests that early diagnosis of amyloidosis may be possible through recognizing varied cardiac presentations.
  • Underscores the need for further research into the diverse clinical manifestations of systemic amyloidosis.