Acute heart failure and cardiogenic shock: modern principles of diagnosis and treatment

M.O. Harbar, H.V. Svitlyk, Ya.M. Pidhirnyy, Yu.O. Svitlyk

Abstract


Acute heart failure is life-threatening medical condition that requires urgent evaluation and optimal treatment. The article considers the modern point of view on acute heart failure according to the European Society of Cardiology Guidelines on the treatment of heart failure (2016), acute myocardial infarction in patients with ST elevation (2017) and acute myocardial infarction in patients without persistent ST elevation (2015). The article describes the main underlying precipitants and causes of acute heart failure onset (both cardiac and non-cardiac). Attention is paid to different classification approaches based on various criteria — triggering factors (leading to decompensation), level of blood pressure, clinical profile of a person, T. Killip and J. Kimball classification in case of acute coronary syndrome. Clinical classification is modern and is based on bedside physical examination of a patient in order to detect signs of peripheral hypoperfusion and/or congestion that allow identifying four clinical groups and starting appropriate initial treatment. Since the specificity and sensitivity of clinical findings are often not sa­tisfactory, there are additional investigations — instrumental and laboratory tests; their diagnostic role, advisability, and time of conduction are considered. Criteria for hospitalization in intensive care unit are given. Also recommendations for the management of early phase with oxygen supply and ventilator support are described. Attention is focused on non-invasive positive pressure ventilation (continuous positive airway pressure and bilevel positive airway pressure) in patients with respiratory distress syndrome that should be started as soon as possible to reduce the rate of endotracheal intubation. Pharmacotherapy of acute heart failure is described, including peculiarities of vasodilators, vasopressors and inotropic agent administration. Early reperfusion strategy and implementation of device therapy (renal replacement therapy, mechanical assist devices) were stressed.

Keywords


acute heart failure; cardiogenic shock; classification; diagnostic algorhythm; treatment

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DOI: https://doi.org/10.22141/2224-0586.3.90.2018.129486

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