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Related Concept Videos

Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

1.4K
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...
1.4K
Imbalances in Cardiac Output01:26

Imbalances in Cardiac Output

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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.
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
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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...
334
Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

298
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...
298
Heart Failure Drugs: Inotropic Agents01:26

Heart Failure Drugs: Inotropic Agents

451
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...
451
Heart Failure Drugs: β-Blockers01:22

Heart Failure Drugs: β-Blockers

287
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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Related Experiment Video

Updated: May 17, 2025

Implantation of Total Artificial Heart in Congenital Heart Disease
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Managing Heart Failure in Complex Adult Congenital Heart Disease.

Tzvi Fishkin1, Ashish Tripathi1, Muhammad Furqan1

  • 1From the Department of Medicine, Westchester Medical Center, Valhalla, NY.

Cardiology in Review
|May 14, 2025
PubMed
Summary

Adults with complex congenital heart disease face high rates of heart failure. Management requires tailored strategies due to unique anatomy and physiology, with a need for more research on effective medical therapies.

Keywords:
Fontanadvanced therapiescongenital heart diseaseheart failureheart transplantsingle ventriclesystemic right ventricle

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Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Adult Congenital Heart Disease

Background:

  • Complex congenital heart disease (CCHD) management has advanced, enabling more children to survive into adulthood.
  • This growing population often has complex anatomy and physiology, leading to a high prevalence of heart failure (HF).
  • HF in adults with CCHD differs from HF in the general adult population.

Purpose of the Study:

  • To review the current understanding of heart failure in adults with complex congenital heart disease.
  • To highlight the unique challenges in managing HF in this population.
  • To identify gaps in knowledge and areas for future research.

Main Methods:

  • Literature review of studies on heart failure in adults with CCHD.
  • Analysis of current management guidelines and therapeutic options.
  • Synthesis of data on the impact of CCHD and palliative surgeries on HF development.

Main Results:

  • Adults with CCHD have a high incidence of progressive heart failure.
  • Anatomical and physiological sequelae of CCHD and its surgical palliation contribute to HF.
  • Current management strategies need adjustment for the unique patient profile.
  • Limited data exist on medical therapies to improve symptom burden and mortality.

Conclusions:

  • Heart failure is a significant and progressive issue for adults with CCHD.
  • Management must be individualized, considering unique anatomy and physiology.
  • Further research and large-scale trials are crucial for optimizing HF treatment in this population.
  • Advanced therapies like mechanical circulatory support and transplant are often necessary for decompensated HF.