Cardiac Failure in Intensive Care

Overview

Heart failure represents almost 5 % of all hospital admissions and both mortality and health care cost on account of thosepatients are high. The proportion of patients on ICU with heart failure of various origin (mostly as a results either of primaryheart damage or as a result of secondary heart damage due to multiple organ failure) has increased rapidly during the lasttwo decades. Heart failure occurs mostly as a result of ischaemic heart disease and the prevalence of heart failure increasesin those with both ischaemic heart disease and hypertension.Increased sympathetic activity, renin-angiotensin–aldosterone axis, vasopressin, endothelin and atrial natriuretic peptidesplay the most important role in developing heart failure. Current definitions, diagnosis and recommended treatment of heartfailure are based on recommendation issued by European Society of Cardiology. Echocardiography together with assessmentof atrial natriuretic peptide plasma levels are preferred methods for diagnosis.The current therapeutic approach to heart failure is stratified according to levels of evidence based medicine methodology.The control of underlying cause and optimizing of myocardial oxygen delivery to failing heart without increasing oxygenconsumption at the same time represent the cornerstone of therapy in heart failure patients. Diuretics, vasodilators togetherwith inotropic agents (dobutamine, phosphodiesterase inhibitors and recently calcium sensitizers, if necessary), are themostrecommended drugs in this setting.ACE inhibitors and beta-blockers are the key agents for long-term pharmacologicaltherapy in chronic heart failure patients. Non-pharmacological modalities are also mentioned.

Key words:
heart failure – pathophysiology – diagnosis – treatment – guidelines