Initial assessment and management of Acute Heart Failure Syndromes

Posted: Saturday, May 7, 2011 | Posted by Debajyoti Datta | Labels: ,

I am back after a prolonged hiatus and will take a look at the early management of acute heart failure in this post. In a recent commentary published in JAMA, Mihai Gheorghiade and Eugene Braunwald, the doyen of cardiology have proposed a model for the assessment and management of patients presenting with acute heart failure. They consider patients in phase 1 of acute heart failure who require urgent treatment and stabilization.

The patients have been classified in a 6 axis model under the categories of –
  1. Clinical severity
  2. Blood pressure
  3. Heart rate and rhythm.
  4. Precipitants
  5. Comorbidities
  6. De novo or chronic heart failure
Modified from Gheorghiade M, & Braunwald E (2011). A proposed model for initial assessment and management of acute heart failure syndromes. JAMA : the journal of the American Medical Association, 305 (16), 1702-3 PMID: 21521852
I have summarized the model in the form of an algorithm. The grading of congestion is suggested to be done according to a scale available here.

However, there are few questions that remain unanswered.
  • The authors caution against the use of inotropes like dobutamine in patients with hypotension but what alternative therapy should be tried is not indicated.
  • The authors remark that in patients with concomitant renal abnormality, the interaction between heart failure and renal function is complex and the response to therapy may depend on this interaction but do not comment on the management of these subgroup of patients.
ResearchBlogging.org
Gheorghiade M, & Braunwald E (2011). A proposed model for initial assessment and management of acute heart failure syndromes. JAMA : the journal of the American Medical Association, 305 (16), 1702-3 PMID: 21521852

27 comments:

  1. Felix said...
  2. I'm 52 yrs of age, male, 5'6" inches tall and 172 lbs. I have a 1" bleb on my right lung and my BP goes up to 150/100 when I drink too much water or eat something salty. Mostly at night, or after physical exertion or tense, I feel breathless and about to "run out of air" with some pain on my upper front teeth and middle of my left palm. I have had a battery of test but all that was found was a premature ventricular beat on my 2d echo and was told that it is something benign that they don't usuall treat. Once I had an xray and the impression on was early congestive heart failure. I am confused but still have the symptoms at least once a week. I would be very happy to know what my condition is. Anyone?

  3. sandar loredana said...
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  5. sandar loredana said...
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  9. Becky Lynch said...
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  11. Becky Lynch said...
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  13. Lora James said...
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  19. Florence charlott said...
  20. Happiness is all i see now I never thought that I will be cured from HERPES virus again. I have been suffering from a deadly disease (HERPES) for the past 3 years now, I had spent a lot of money going from one places to another, from churches to churches, hospitals have been my home every day residence. Constant checks up have been my hobby not until this faithful day, I was searching through the internet, I saw a testimony on how DR Ohunyom helped someone in curing his HERPES disease, quickly I copied his email which is
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  21. Unknown said...
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  23. Florence charlott said...
  24. I want to write a little testimony about the good work of doctor ehiaguna who cured me from Hsv 1 and 2 for just 2 week with his herbal medicine, I never believe I can be normal again and have a good life like others I always regretted the day I got diagnose with the virus, I was lost of hope when my doctor told me there is no cure for it but I keep thinking and thinking about my future, if I can have kids of my own well I am so grateful for my helper who get me cured with his herbal medicine, I go online in search of anything that can help me because I can’t deal with it forever so I found this doc ehiaguna email on a blog of someone who was cured by him I quickly contact him for help and explain all my pain to him, he told me not to worry about it there is cure for real, I never believe until he send me the herbal medicine when I order for it and I have it within 4 days that is how I took the medicine for 2 week and the following week I go for test just to confirm I was 100% cured from this sickness what a miracle in my life I am so happy right now, you can also get in contact with him if you have such sickness through drehiaguna@gmail.com and also WhatsApp him +2348073908953... And He also have herbs medicine to cured the following diseases; eczema,urethra wart,chronic problems.Herpes, Cancer, Als,Hepatitis, Diabetes, HPV,Infections,ulcer  ETC

  25. Glen Charles said...
  26. I am 58 years old, and was diagnosed with heart failure over a year ago. My main symptoms was fatigue, shortness of breath, and a general sense that these symptoms will keep me out of normal life activities, my symptom was not being able to breathe when lying down basically . I’ve kind of resigned to the fact that this is how life will be for me back until I found herbs that stop this CHF easily and relief all the airways. My wife and her caregiver assume I can't be as active, and thus I was excused from normal life responsibilities but natural herbs from www. totalcureherbsfoundation. com really helped a but sometimes I think is God prodigy that I was able to treat my congestive heart failure but total cure herbs foundation herbal formula has a big impact on my recovery because my heart condition has been fully eliminate, during your order you have choose the AATD herbal remedy on their website order list to get the right treatment for Congestive heart failure . They do things for me, and was too happy to comply with their service. This is a equitable of a way to get of your heart failure.

  27. Sallow Villin said...
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  29. Albert said...

  30. I was having Herpes Simplex Virus then i came across a review of people saying that they got treated from Herpes Simplex Virus by Dr Voke., So i gave a try by contacting him through his email and explain my problem to him. He told me all the things I need to do and also give me instructions to take, which I followed properly. Before I knew what is happening after two weeks the HERPES SIMPLEX VIRUS that was in my body got vanished . so if you are also heart broken by any deadly diseases like HERPES HIV, shingles,low sperm count or bringing back your ex lover, this great man is extremely the best in which I have seen and applauds and if you also need a help, you can also email him via email {{ doctorvoke@gmail.com }} ,,,

  31. LUSSIE KANYE said...
  32. I am really happy that i have been cured from (HERPES SIMPLEX VIRUS) with the herbal medicine of DRASHAOSEMUDIAMEN, i have been suffering from this disease for the past 2 years and 7 month without solution until i came across the email of this doctor who have cure so many people with his herbal medicine, i also choose to give him a chance to help me and my husband, he told me what to do and i kindly did it, and he gave us his herbal medicine and direct me on how to use it, i also follow his instructions for use and he ask us to go for a check up after 1 week and 4days which i did, to my greatest surprise our result came out as negative, we are really happy that there is someone like this doctor who is ready to help anytime any day. To all the readers and viewers that are doubting this testimony, stop doubting it and contact this doctor if you really have one and see if he will not actually help you. i am not a stupid woman that i will come out to the public and start saying what someone have not done for me and i know that there are some people out there who are really suffering and hurting their family just because of these diseases so you can email him on drashaosemudiamen@gmail.com or you can also whatsapp/call him on +234‭7052021645‬ CAN AS WELL CURE THE FOLLOWING DISEASE:-1. HERPES2. PENIS ENLARGEMENT3. GONORRHEA4. HIV/AIDS5. LOW SPERM COUNT6. MENOPAUSE DISEASE7. EPILEPSY8. ASEPSIS9. CANCER10. ANXIETY DEPRESSION11. PREGNANCY PROBLEM12. SHORT SIGHTEDNESS PROBLEM13.YOU NEED YOUR WIFE OR HUSBAND BACK14. PTSD15 ADHD.. ..

  33. patrick morrison said...
  34. HOW I GOT CURED OF HERPES DISEASE
    I'm here to testify about what DR. ANUGE did for me. I have been suffering from (HERPES) disease for the past 5 years and had constant pain,especially inside my body. During the first year,I had faith in God that i would be healed someday. This disease started circulating all over my body and i have been taking treatment from my doctor, few weeks ago i came across a testimony of one lady on the internet testifying about a Man called DR. Anuge on how he cured her from herpes disease. And she also gave the email address of this man and advise anybody to contact him for help for any kind of sickness that he would be of help.so I emailed him telling him about my (HERPES) he told me not to worry that i was going to be cured!! Well i never believed it,, well after all the procedures and remedy given to me by this man few weeks later i started experiencing changes all over me as DR. ANUGE assured me that i will be cured,after some time. i went to my doctor to confirmed if i have be finally healed behold it was TRUE, the test came out negative. So friends my advise is if you have such sickness or any other at all you can contact DR. Anuge for help. Email} dranuge@gmail.com WhatsApp /call +2348164866838

  35. kelvin edward said...
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  37. vera white said...
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  39. Laura Mildred said...
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  41. melody bella said...
  42. Here is my testimony on how i was cured from (HERPES SIMPLEX VIRUS) with the herbal medicine of Dr Oseremen, i have been suffering from this disease for the past 10 years without solution until i came across the email of this doctor who have cure so many people with his herbal medicine, i also choose to gave him a chance to help me and my husband, he told me what to do and i kindly did it, and he gave us his herbal medicine and direct me on how to use it, i also follow his instructions for use and he ask us to go for a check up after 2 weeks which i did, to my greatest surprise our result came out as negative, we are really happy that there is someone like this doctor who is ready to help anytime any day. To all the readers and viewers that is doubting this testimony stop doubting it and contact this doctor if you really have one and see if he will not actually help you. i am not a stupid woman that i will come out to the public and start saying what someone have not done for me and i know that there are some people out there who are really suffering and hurting their family just because of these diseases so you can to Emaill Dr.Oseremenvadi@gmail.com on or you can also call him on +2349056394313 he also told me that he has cure for these diseases listed below . HERPES SIMPLEX VIRUS. .DIABETES . CANCER .HEPATITIS .HIV/AIDS Thank you for your time .

  43. Tamara Barrow said...
  44. Natural herbs have cured so many illness that drugs and injection cant
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  45. Moran Bella said...
  46. Hello everyone, sharing this testimony is my greatest happiness also to let every patient know there is cure to get rid of human papillomavirus. I was once a HPV patient for a very long time. I have been taking medications because my doc in Canada told me there is no cure except pills to control it which I have been taking. Until I found a faithful and truthful herbalist who finally cured me with herbal remedy. Everything about the virus was gone, my genital warts I have been trying to remove, they all cleared off. Here is the herbalist information to reach him via : oyaguherbalhome@gmail.com or whatsapp +2348101755322 his website https://oyaguspellcaster.wixsite.com/oyaguherbalhome. Dr Oyagu is great and very kind to every patient. He also Cure 1.HIV/AIDS

    2.HERPES

    3 CANCER of all kind

    4.HSV 1&2

    5.Herpatitis B

    6.Diabetes

    7.HPV

  47. Martha Harding Dyson said...
  48. why suffering in sickness and in pain when there is a genuine herbal doctor call DR JOHN ,that can tracdomedically cure and heal you of your disease.. am a living testimony to what DR JOHN has done for me.. Anyway, my name is Daniel Bohm, from Omaha, Nebraska in America. for about 4 years now, i have been diagnose of herps, and the situation was eaten me badly.. out of frustration, i started search on Internet and in the world in search of solutions to my ailment.. i stumble on DR JOHN testimony on how he cure a woman of herps, i decided to give it a try because i was fed up on Google not knowing who to trust again.i decided to give it a try, to my greatest surprise he administer a herbs to me and i was cure of my disease.. because of the good thing that this great man has done for me, i promise to tell DR JOHN good works he has done for saving my life to the whole world. those passing through such problem should contact DR JOHN via email; drjohnhivcurehome@gmail.com or whatsapp number +2347064365391
    for more solution to your problems,
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    Goodluck in life

    and all kind of diseaseHpatities A, B

    Ex-lover Back

  49. Diane Lawson said...
  50. i am so glad to write this article today to tell the world how Dr. Ohunyom cured my HPV virus that have been in my body since five years ago, ever since then my life has been in complete,i have used so many drugs that was prescribed to me by several doctors,but it didn't cure my HPV VIRUS neither did it reduce the pain, i was checking for solution on the internet then miraculously came across Dr. Ohunyom the powerful herbalist that cure HPV INFECTION,then i contacted his email, i explained everything to him and he prepared a herbal cure and send it to me that was how i got cured from HPV disease totally after receiving his herbal medicine, so my friends viewers why waiting and be suffering with this HPV virus when there is someone like Dr. Ohunyom that can get you cured completely. you can contact his Email via:drohunyom@gmail.com and also WhatsApp him +2349060579973 And He also have herbs medicine to cured the following diseases; eczema,urethra wart,chronic problems.Herpes, Cancer, Als,Hepatitis, Diabetes, HPV,Infections,ulcer  ETC

  51. Monica Daniels said...
  52. I had body itching, pain during urination and blistering sores on my genital area. So, I went to the hospital for treatment and was diagnosed for HERPES SIMPLEX VIRUS. I was given some Antiviral medications to reduce the severity, but it got worse with the pain and its reappearing was longer than the disappearing. So, I went seeking other means to cure the disease and that was how I got to know Dr. Oda who helped cure the disease. It’s been a year since I got cured and i haven’t had any pain or symptoms of HSV. Also, i was confirmed negative at the hospital. You too can be rescued by this doctor. Contact: (drodasolution@gmail.com Tel/whatsapp: +234 805 761 6299)

  53. Maria Kana said...
  54. Goji Berries... yes... I tried those too.For my health conditions, Those sweet, red berries seemed to help, but only during the time when I consumed them. I don't want to take a drug for the rest of my life, so why would I want to take a natural supplement everyday for the rest of my life (although Goji berries are very tasty and are highly nourishing). To me this was not a cure either (and I'm LOOKING for the CURE).
    Up to that point, I hadn't found a cure. I felt like a young jumbled mess. I continued to have extreme pain, but continued on my path to healing. I started to focus on myself and not everyone else. When I was a young adult, I took on too much responsibility out of a sense of obligation. This was no longer healthy for me, so I resigned from all my projects and groups. Those days to come were the best [and worst] days. I took a lot of time off work, yet began to feel so extremely exhausted. Many health professionals "diagnosed" me with adrenal fatigue & Hiv,Prostate Cancer so my situation was annoying then I keep searching for permanent cure online that's when I came to know of Dr Itua herbal center hands whom god has blessed with ancestral herbs and a gift to heal people with diseaseSo I made a purchase of his herbal medicines and I have been watching my health for 6 years now and I actually confirmed that his herbal medicines are a permanent cure and I'm so happy that I came to know of his herbal healings.You can contact Dr Itua herbal center Email: drituaherbalcenter@gmail.com www.drituaherbalcenter.com if you went through exactly what I go through in terms of health conditions because to be honest there is more to learn about natural herbs than medical drugs.

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