Ultrasound guidance for volume management in patients with heart failure
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Ultrasound guidance for volume management in patients with heart failure Michael J. Bonios 1
&
Stamatis Kyrzopoulos 2 & Dimitris Tsiapras 2 & Stamatis N. Adamopoulos 1
# Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Congestion is one of the most prominent characteristics of patients presented with decompensated heart failure and it implies unfavorable prognosis for the heart failure patient. Neurohumoral and immuno-inflammatory activation secondary to cardiac dysfunction constitute the pivotal mechanisms driving the heart failure syndrome that results in progressive fluid accumulation. In addition, fluid redistribution between different vascular compartments in human body guided from sympathetic activity constitutes another mechanism for heart failure decompensation. Ultrasound applied in the form of echocardiography provides invaluable data for the assessment of intracardiac filling pressures. The type of renal venous flow can provide the degree of renal congestion and probably insight into the pathophysiology of the decompensation of heart failure. Assessment of lung congestion in the patient with heart failure can be accomplished by lung ultrasonography. Additionally, clinical studies on the role of ultrasound in the management and prognosis of the congested patient are reviewed. Special heart failure population supported with left ventricular assist devices and extracorporeal membrane oxygenation support constitute an area where ultrasound guidance of fluid management has gained important role. Keywords Heart failure . Congestion . Ultrasonography
Abbreviations AHF Acute heart failure BNP Brain natriuretic peptide CaTUS Cardiothoracic ultrasound CVP Central venous pressure ECMO Extracorporeal membrane oxygenation IVC Inferior vena cava LUS Lung ultrasonography LV Left ventricle LVAD Left ventricular assist device PAC Pulmonary artery catheter RVF Renal venous flow VA Venoarterial
* Michael J. Bonios [email protected] 1
Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, 356 Sygrou Av, 176 74 Athens, Greece
2
Noninvasive Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
Introduction Congestion is one of the most prominent characteristics of patients presented with decompensated heart failure [1]. Data from large European and American registries reveal that dyspnea was the main symptom in 89% of patients, and lung congestion was identified at rates 70–75% [2]. The likelihood of being hospitalized is increased going in parallel with elevated filling pressures in the left or right heart. Congestion is a characteristic that implies unfavorable prognosis for the heart failure patient. In the SOLVD treatment trial, those patients with the presence of S3 cardiac tone or distended jugular veins had significantly worse long-term prognosis compared with their counterparts that did not have those characteristics [3].
Pathophysiology of congestion in heart failure Neurohumoral and immuno-inflammatory activation secondary to cardiac dysfunction con
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