Abstract

CHAVEZ-ALFONSO, Christian Osmar  and  CENTURION, Osmar Antonio. Physiopathological, neurohormonal and therapeutic targets in acute heart failure. Mem. Inst. Investig. Cienc. Salud [online]. 2019, vol.17, n.3, pp.82-96. ISSN 1812-9528.  https://doi.org/10.18004/mem.iics/1812-9528/2019.017.03.82-096.

Acute heart failure (AHF) is defined as the rapid onset or worsening of the symptoms or signs of heart failure. It is a potentially fatal entity that requires urgent evaluation and treatment and typically involves urgent hospitalization. Decompensation of chronic heart failure can occur without known triggers. An endothelial dysfunction occurs that may be due to an imbalance in the neuro-hormonal, inflammatory, and oxidative environment in the circulation and in the endothelial cells. Myocardial hypoperfusion is clinically produced, coronary flow reduction, ischemic dysfunction, increased vascular rigidity and deterioration of arterial compliance that aggravate myocardial injury to a greater extent. Initial evaluation and continuous non-invasive monitoring of vital cardiorespiratory functions are essential. Diuretics are the cornerstone of the treatment of patients with AHF and signs of fluid overload and congestion. Renal replacement therapy should be reserved for patients who do not respond to treatment with diuretics. Intravenous vasodilators are the second most used drugs in the AHF for the relief of symptoms; however, there is no definitive evidence to confirm its beneficial effect. The use of inotropics should be reserved for patients with systolic dysfunction that affects the perfusion of vital organs. Ventricular assist devices and other forms of mechanical circulatory assistance can be used as a bridge treatment in selected patients.

Keywords : Acute heart failure; pathophysiology; therapeutic management.

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