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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 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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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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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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Updated: Jan 11, 2026

Reduction in Left Ventricular Wall Stress and Improvement in Function in Failing Hearts using Algisyl-LVR
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SGLT2-is in Acute Heart Failure.

Matteo Bianco1,2, Concetta Di Nora1,3, Renata De Maria1,4

  • 1Area Scompenso Cardiaco, Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO), 50121 Firenze, Italy.

Journal of Clinical Medicine
|November 13, 2025
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Summary

The optimal timing for initiating SGLT2 inhibitors in acute heart failure remains debated. Current guidelines suggest early use, but evidence from recent trials provides mixed results on mortality benefits.

Keywords:
SGLT2iacute heart failuredecongestion

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Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Evidence supports SGLT2 inhibitors for chronic heart failure.
  • Their role in early-stage acute heart failure is less clear.
  • Guidelines offer conflicting advice on initiation timing.

Purpose of the Study:

  • To review current evidence on SGLT2 inhibitor use in early acute heart failure.
  • To analyze the pathophysiological rationale for their early application.

Main Methods:

  • Review of European Society of Cardiology and American College of Cardiology guidelines.
  • Analysis of data from EMPULSE, SOLOIST-WHF, and DAPA ACT HF-TIMI 68 trials.

Main Results:

  • ESC guidelines advocate SGLT2 inhibitors in acute phases but lack specific timing.
  • ACC consensus supports early initiation regardless of ejection fraction.
  • DAPA ACT HF-TIMI 68 showed no reduction in mortality or hospitalizations at 2 months.

Conclusions:

  • SGLT2 inhibitors show promise in early acute heart failure, with ACC supporting in-hospital initiation.
  • Further research is needed to clarify optimal timing and long-term benefits.
  • The pathophysiological rationale for early use warrants practical consideration.