9
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Tratamento atual da insuficiência cardíaca descompensada Translated title: Current insights into the modern treatment of decompensated heart failure

      case-report

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          O tratamento de ICD representa um desafio até mesmo para o médico experiente. Os avanços alcançados nas pesquisas propiciaram novas opções de tratamento que estão ajudando a mudar paradigmas. As evidências indicam que novos fármacos como a levosimendana e nesiritida representarão importantes alternativas ou complementos ao tratamento com medicamentos inotrópicos tradicionais, como a dobutamina. O médico responsável pelo tratamento desses pacientes deve aprender a usar as melhores evidências disponíveis para individualizar o tratamento com segurança e eficácia.

          Translated abstract

          Treatment of DHF is a challenge even for the experienced physician. Advances in research have brought new treatment options that are helping change paradigms. The available evidence suggests that new drugs like levosimendan and nesiritide will assume relevant positions as alternatives or complements to treatment with traditional inotropic drugs like dobutamine. The physician responsible for treating these patients should learn how to use the best available evidence, in order to tailor treatment with safety and efficacy.

          Related collections

          Most cited references76

          • Record: found
          • Abstract: found
          • Article: not found

          The effect of digoxin on mortality and morbidity in patients with heart failure.

          (1997)
          The role of cardiac glycosides in treating patients with chronic heart failure and normal sinus rhythm remains controversial. We studied the effect of digoxin on mortality and hospitalization in a randomized, double-blind clinical trial. In the main trial, patients with a left ventricular ejection fraction of 0.45 or less were randomly assigned to digoxin (3397 patients) or placebo (3403 patients) in addition to diuretics and angiotensin-converting-enzyme inhibitors (median dose of digoxin, 0.25 mg per day; average follow-up, 37 months). In an ancillary trial of patients with ejection fractions greater than 0.45, 492 patients were randomly assigned to digoxin and 496 to placebo. In the main trial, mortality was unaffected. There were 1181 deaths (34.8 percent) with digoxin and 1194 deaths (35.1 percent) with placebo (risk ratio when digoxin was compared with placebo, 0.99; 95 percent confidence interval, 0.91 to 1.07; P=0.80). In the digoxin group, there was a trend toward a decrease in the risk of death attributed to worsening heart failure (risk ratio, 0.88; 95 percent confidence interval, 0.77 to 1.01; P=0.06). There were 6 percent fewer hospitalizations overall in that group than in the placebo group, and fewer patients were hospitalized for worsening heart failure (26.8 percent vs. 34.7 percent; risk ratio, 0.72; 95 percent confidence interval, 0.66 to 0.79; P<0.001). In the ancillary trial, the findings regarding the primary combined outcome of death or hospitalization due to worsening heart failure were consistent with the results of the main trial. Digoxin did not reduce overall mortality, but it reduced the rate of hospitalization both overall and for worsening heart failure. These findings define more precisely the role of digoxin in the management of chronic heart failure.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial.

            H Dargie (2001)
            The beneficial effects of beta-blockers on long-term outcome after acute myocardial infarction were shown before the introduction of thrombolysis and angiotensin-converting-enzyme (ACE) inhibitors. Generally, the patients recruited to these trials were at low risk: few had heart failure, and none had measurements of left-ventricular function taken. We investigated the long-term efficacy of carvedilol on morbidity and mortality in patients with left-ventricular dysfunction after acute myocardial infarction treated according to current evidence-based practice. In a multicentre, randomised, placebo-controlled trial, 1959 patients with a proven acute myocardial infarction and a left-ventricular ejection fraction of
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Use of dopamine in acute renal failure: a meta-analysis.

              To determine whether low-dose dopamine administration reduces the incidence or severity of acute renal failure, need for dialysis, or mortality in patients with critical illness. We performed a MEDLINE search of literature published from 1966 to 2000 for studies addressing the use of dopamine in the prevention and/or treatment of renal dysfunction. Data were abstracted regarding design characteristics, population, intervention, and outcomes. Results of individual randomized clinical trials were pooled using a fixed effects model and a Mantel-Haenszel weighted chi-square analysis. We identified a total of 58 studies (n = 2149). Of these, outcome data were reported in 24 studies (n = 1019) and 17 of these were randomized clinical trials (n = 854). Dopamine did not prevent mortality, (relative risk, 0.90 [0.44-1.83]; p =.92), onset of acute renal failure (relative risk, 0.81 [0.55-1.19]; p =.34), or need for dialysis, (relative risk, 0.83 [0.55-1.24]; p =.42). There was sufficient statistical power to exclude any large (>50%) effect of dopamine on the risk of acute renal failure or need for dialysis. The use of low-dose dopamine for the treatment or prevention of acute renal failure cannot be justified on the basis of available evidence and should be eliminated from routine clinical use.
                Bookmark

                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                abc
                Arquivos Brasileiros de Cardiologia
                Arq. Bras. Cardiol.
                Sociedade Brasileira de Cardiologia - SBC (São Paulo )
                1678-4170
                September 2006
                : 87
                : 3
                : 369-377
                Affiliations
                [1 ] Hospital Espanhol Brasil
                [2 ] UniversitätsSpital Zürich Switzerland
                Article
                S0066-782X2006001600022
                10.1590/S0066-782X2006001600022
                8b6ec4f3-bb63-456b-b619-0399487a027a

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0066-782X&lng=en
                Categories
                CARDIAC & CARDIOVASCULAR SYSTEMS

                Cardiovascular Medicine
                aguda,descompensada,tratamento,acute,decompensated,treatment,Insuficiência cardíaca,Heart failure

                Comments

                Comment on this article