Resumo

LOBO MARQUEZ, Lilia Luz. New paradigms about "congestive issues" in acute heart failure. Insuf. card. [online]. 2009, vol.4, n.3, pp.136-141. ISSN 1852-3862.

To think that we are only "calming symptoms" while improving a congestive patient, is a very simplistic idea. Lowering the left ventricular filling pressures, when these are high, changes forecast not only by modifying quality but also changing quantity of life. The difficulty to diagnose and to treat appropriately these patients is reflected in the frequent dissociation: symptom-clinic-hemodynamic. The persistent congestion, even more the clinically not diagnosed one, damages the viable heart muscle favoring cellular death and the progression of heart failure. The importance of the systemic impact of congestive patterns is reflected by the clinical evidence of the damage of white organs that, not long ago, was considered as an exclusive setting of low cardiac output (cardiorrenal-liver syndrome estasy). We cannot exclude the utility of hemodynamic data as therapeutic target. It is probable that we should still learn more about how to interpret and to manage this information to optimize its implementation. The systemic vascular resistances begin to play a fundamental role in the initiation of vascular and congestive pictures. A probable systemic endotelitis, product of inflammatory triggers would raise the systemic vascular resistances initially generating a secondary arterial-ventricle mismatch that would take to tables of acute pulmonary edema. These types of clinical presentation course in most of the cases with preserved left ventricular ejection fraction. Of course we should modify our thought on "old paradigm of congestive topics" based on traditional physiopathological concepts, so it will allow us to expand new horizons on the diagnostic and therapeutic field of acute heart failure.

Palavras-chave : Acute heart failure; Congestion; Hemodynamic; Inflammation.

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