About-Cardio
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We provide our users the most up-to-date and accurate information on the treatment and prevention of cardio pathologies in accordance with current American and European clinical guidelines.
The information provided on this website is for educational purposes only and should not be considered medical advice. Always consult a licensed physician for diagnosis and treatment.
Refractory Heart Failure
Introduction
Refractory heart failure (RHF) is the most advanced stage of heart failure (HF), where symptoms persist despite optimal medical therapy. Managing this condition is challenging and requires a multidisciplinary approach.
Causes and Risk Factors
- Progression from chronic heart failure
- Ineffective response to standard treatments
- Severe comorbidities, such as kidney disease, diabetes, or pulmonary hypertension
- Frequent hospitalizations leading to worsening cardiac function
Symptoms
- Severe shortness of breath (dyspnea) at rest
- Persistent fluid retention (swelling in legs, ascites)
- Fatigue and weakness
- Frequent hospital admissions for decompensation
Diagnosis
- Echocardiography: To assess ejection fraction and heart structure
- Blood tests: Including BNP/NT-proBNP to evaluate heart stress
- Right heart catheterization: To measure pulmonary pressures
- Cardiac MRI or CT: To assess structural abnormalities
Treatment Strategies
- Optimization of Medical Therapy
- Increasing or adjusting guideline-directed medications such as ARNIs, beta-blockers, MRAs, and SGLT2 inhibitors
- Advanced Therapies
- Cardiac resynchronization therapy (CRT) if indicated
- Left ventricular assist device (LVAD) for mechanical support
- Heart Transplantation
- Considered for eligible patients with end-stage HF
- Palliative Care
- Symptom management and improving quality of life, especially in patients ineligible for advanced interventions
Prognosis
Without advanced interventions, RHF has a high mortality rate. Therefore, early referral to specialized heart failure centers is crucial.
Conclusion
Refractory heart failure is a critical condition that requires aggressive and specialized management. Patients should be under the care of a multidisciplinary team, considering advanced therapies when appropriate.
Source recommendations
1. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
- https://pubmed.ncbi.nlm.nih.gov/35378257/
- https://www.sciencedirect.com/science/article/pii/S0735109721083959
- https://professional.heart.org/en/science-news/2022-guideline-for-the-management-of-heart-failure
- https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2022/03/29/19/53/2022-AHA-ACC-HFSA-Heart-Failure-Guideline-gl-hf
2. 2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure
- https://pubmed.ncbi.nlm.nih.gov/34447992/
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
- https://academic.oup.com/eurheartj/article/42/36/3599/6358045
- https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.2333
- https://academic.oup.com/eurheartj/article/44/37/3627/7246292
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
The heart is an organ that does not know how to "keep silent" if something goes wrong. Chest pain, shortness of breath, swelling, dizziness, and rhythm disturbances are the symptoms that require our attention. The best prevention of heart disease is careful attention to your health, regular checkups with a doctor, and a healthy lifestyle. Take care of your heart, and it will serve you for many years!
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Every 3-5 years, half of the scientific approaches to treatment in the field of cardiology are reviewed as a result of specialized scientific discoveries. With us, you don't have to wait these years to learn about the best ways to treat you and your loved ones.