Acute heart failure treatment

Czech version

Authors: J. Špinar ¹; J. Pařenica ¹; L. Špinarová ²; J. Vítovec ²
Authors‘ workplace: Interní kardiologická klinika LF MU a FN Brno ¹; I. interní kardioangiologická klinika LF MU a FN u sv. Anny v Brně ²
Published in: Kardiol Rev Int Med 2014, 16(3): 171-177
Category: Cardiology Review

Overview

Treatment of acute heart failure remains complicated and in-hospital mortality remains high at 10%. Diuretics are still the drug of first choice, mainly loop diuretics. It is important to treat complications like infections, diabetes mellitus, etc. Other treatments can be divided into vasodilators and positive inotropic drugs. Vasodilators are especially suitable for patients with BPs > 100 mmHg or even > 115 mmHg, and the drugs of choice include nitrates and nitroprusside. Nesiritide has not shown a decrease in mortality, while ularitide and serelaxin are being tested. Dopamine, dobutamine and phosphodiesterase 5 inhibitors are representatives of positive inotropic drugs, but none of them has clear mortality data. Promising data were shown with omecamtiv mecarbil, but the first mortality trial, ATOMIC, showed neutral results. Levosimendan is the only calcium sensitizer with a large clinical program and with neutral and slightly positive results. Repetitive use of levosimendan is also recommended. Antiaggregation, anticoagulation, analgesics and sedatives are also part of acute heart failure treatment, as well as oxygen and non-pharmacological methods.

Keywords:
acute heart failure – diuretics – vasodilators – inotropes – levosimendan

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