[CRT-FORUM] 54S Management for heart failure. Dr. Sotomayor Perales

[CRT-INFO]

Dear friends of the forum,
The sessions that are being discussed are really great; I would like, with
your permission, to go back for a while, to the excellent summary on the
approach to the management of heart failure (HF) that the master Perez Riera
made as a reply to Dr. Triana from Cuba, and I would like to just add that
(since I was asked this by an internal medicine resident from our hospital)
it is necessary to differentiate the different “evolutionary stages” of HF,
since this is a continuing process, what we call the “natural evolution of
the disease” and in this context the therapeutic approach also present
particularities:
“Acute” heart failure (although this term became confusing) represents a
critical state where we have to act quickly (e.g., acute HF by MI,
arrhythmia, HBP, etc.), so besides all the care from the heart failure unit,
we should use as appropriate: counterpulsation balloon, CPAP, BiPAP,
devices, monitoring at times invasive, even and possibly surgery, etc., and
medical management with vasodilators, diuretics, inotropic agents, and so
on.
Primarily compensated chronic heart failure: it has another therapeutic
approach, then ACEI, BB, ARB, aldosterone blockers, renin inhibitors,
digitalis, combination of hydralazine-nitrates, devices, and surgery become
therapeutic alternatives between other novel alternatives, as pointed out by
the Master Perez Riera: external restriction, internal antiremodeling, with
the sole goal of preventing the progression of advanced or refractory HF,
where the devices of ventricular assistance, inotropic management as an
intermediary measure before a possible transplantation, added to the drug
management, become dramatic measurements to extend the life of the patient.
Otherwise, we would be facing a patient with terminal HF in a situation of
admittance into an asylum, which is obligatorily our duty to prevent it. As
you may see, the approach should be focused on the patient. Let’s remember
that we are treating patients (a black patient may even benefit more
hydralazine-nitrates compared to a caucasian one), so it is different
managing a patient with diastolic HF, than one with systolic HF, or a
decompensated one, or that became acute again in the context of chronic HF,
or one that has HF de novo, or even a patient with transient HF. We consider
that we have a half empty glass, and we still have to clarify many consensus
concepts, mainly of terminology, and it would be good if in this forum some
of these may originate on the basis of the HF conference from last year,
which was truly great, and evidently on the basis of guidelines and the
studies available to date. With this commentary I would like to answer the
concerns of my residents, and even some students that follow the forum,
since sometimes they become confused regarding HF concepts and its
therapeutic approach.

Dr. Jorge Sotomayor Perales
Servicio de Cardiología
HOSPITAL NACIONAL "ADOLFO GUEVARA VELAZCO"
CUSCO - PERU

PS: And let us not forget we could prevent all of this by PRIMARY AND
SECONDARY PREVENTION. Let’s work on this.

-- 
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee