Περίληψη:
An episode of acute heart failure syndromes (AHFS) can be defined as a
rapid or gradual onset of signs and symptoms of heart failure (HF) that
result in hospital admission and can arise from a variety of
pathophysiologic mechanisms. This article reviews our current
understanding of the pathophysiology of AHFS in order to identify
potential therapeutic targets. Most patients with AHFS present with
either normal systolic blood pressure or elevated blood pressure.
Patients who present with elevated systolic blood pressure usually have
pulmonary congestion and a relatively preserved left ventricular
ejection fraction (LVEF), and have symptoms that typically develop
abruptly, these patients often are elderly women. Patients with normal
systolic blood pressure presenting with systemic congestion and reduced
LVEF are usually younger, with a history of chronic HF, and have
symptoms that develop gradually over days or weeks. Accordingly, most
episodes of AHFS can be classified as either “vascular” failure or
“cardiac” failure. In addition to the abnormal hemodynamics
(increase in pulmonary capillary wedge pressure and/or decrease in
cardiac output) that characterize patients with AHFS, myocardial
injury-which may be related to a decrease in coronary perfusion and/or
further activation of neurohormones and renal dysfunction (ie, the
cardiorenal syndrome)-probably contributes to short-term and
postdischarge cardiac events. Patients with AHFS also have significant
cardiac and noncardiac underlying conditions that contribute to the
pathogenesis of AHFS, including coronary artery disease (ischemia,
hibernating myocardium, and endothelial dysfunction), hypertension,
atrial fibrillation, and type 2 diabetes mellitus. The goals of therapy
for AHFS should be not only to improve symptoms and hemodynamics, but
also to preserve or improve renal function and prevent myocardial
damage. (c) 2005 Elsevier Inc.
Συγγραφείς:
Gheorghiade, M
De Luca, L
Fonarow, GC
Filippatos, G and
Metra, M
Francis, GS
