1.
Heart Failure Update: Outpatient Management.
Wojnowich, K, Korabathina, R
FP essentials. 2016;:18-25
Abstract
Outpatient management of heart failure (HF) is aimed at treating symptoms and preventing hospitalizations and readmissions. Management is initiated in a stepwise approach. Blockade of the renin-angiotensin system is a cornerstone of therapy and should be started, along with beta blockers, as soon as the diagnosis of HF is made. Other drugs, including diuretics, aldosterone antagonists, hydralazine, and nitrates, may be added based on symptoms and American College of Cardiology/American Heart Association stage. Despite a great interest in and theoretical benefit of naturoceutical products in the mitigation of oxidative stress and HF progression, none has been proven to be beneficial, and concerns exist regarding their interactions with standard HF drugs. Other nonpharmacologic interventions, including sodium restriction, regular exercise, and/or cardiac rehabilitation, should be initiated at diagnosis. HF often is progressive, and clinicians should be aware of late stage management options, including implantable devices, cardiac transplantation, and hospice care.
2.
Levosimendan: a new approach for the treatment of patients with severe heart failure. A brief summary based on a clinical case.
Morais, J, Dias, B, Pontes, N
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology. 2003;(7-8):941-8
Abstract
Looking at the clinical report of a single patients admitted with severely decompensated heart failure and successfully managed with levosimendan, the authors review the current knowledge about this new drug. The treatment of severely decompensated heart failure is currently based on classical catecholamines (dopamine and dobutamine). The various new positive inotropics investigated in the past have failed to improve survival. In spite of some symptomatic improvement an increase in long-term mortality was noticed in different trials testing different drugs. More recently a new concept has been introduced regarding a new way to improve myocardial contractility and vasodilation based on calcium-sensitizing properties with additional action on adenosine triphosphate-sensitive potassium channels. Levosimendan is a representative of this new class recently launched in the Portuguese market.