Congestive heart failure with reduced EF: Difference between revisions

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* It has been proposed that dysregulation in epigenetic signals, cellular messengers and molecular targets precedes pathological cardiac remodeling, disrupts progenitor cell functions, adversely affects the endogenous repair system, and metabolic pathways.
* It has been proposed that dysregulation in epigenetic signals, cellular messengers and molecular targets precedes pathological cardiac remodeling, disrupts progenitor cell functions, adversely affects the endogenous repair system, and metabolic pathways.
*Hypoxia-inducible factor 1 (HIF-1) has been shown to be upregulated in HFrEF. This trasnscription activator is involved in various oxidation-reduction reactions, angiogenesis and vascular remodelling. Myocardial hypoxia leads to its activation which downstream produces elevated levels of brain natriuretic peptide (BNP). Hypoperfusion of peripheral organs leading to hypoxia is the key trigger for induction of increased HIF-1 activity.<ref name="pmid26223692">{{cite journal |vauthors=Li G, Lu WH, Wu XW, Cheng J, Ai R, Zhou ZH, Tang ZZ |title=Admission hypoxia-inducible factor 1α levels and in-hospital mortality in patients with acute decompensated heart failure |journal=BMC Cardiovasc Disord |volume=15 |issue= |pages=79 |date=July 2015 |pmid=26223692 |pmc=4518524 |doi=10.1186/s12872-015-0073-6 |url=}}</ref>
*Hypoxia-inducible factor 1 (HIF-1) has been shown to be upregulated in HFrEF. This trasnscription activator is involved in various oxidation-reduction reactions, angiogenesis and vascular remodelling. Myocardial hypoxia leads to its activation which downstream produces elevated levels of brain natriuretic peptide (BNP). Hypoperfusion of peripheral organs leading to hypoxia is the key trigger for induction of increased HIF-1 activity.<ref name="pmid19542490">{{cite journal |vauthors=Casals G, Ros J, Sionis A, Davidson MM, Morales-Ruiz M, Jiménez W |title=Hypoxia induces B-type natriuretic peptide release in cell lines derived from human cardiomyocytes |journal=Am. J. Physiol. Heart Circ. Physiol. |volume=297 |issue=2 |pages=H550–5 |date=August 2009 |pmid=19542490 |doi=10.1152/ajpheart.00250.2009 |url=}}</ref>


=== Protein kinase B signalling ===
=== Protein kinase B signalling ===
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=== Major biomarkers of HFrEF ===
=== Major biomarkers of HFrEF ===
NT-proBNP, GDF-15, and IL1RL1
NT-proBNP, GDF-15, and IL1RL1
<references />

Revision as of 20:31, 23 December 2019

Congestive Heart Failure Microchapters

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Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
Diuretics
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Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Ultrafiltration
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
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ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

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Congestive heart failure end-of-life considerations

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Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Heart Failure With Reduced Ejection Fraction (HFrEF)

The pathogenesis of HFrEF is related largely to cellular proliferation and metabolism

Activation of DNA binding transcription factors

  • It has been proposed that dysregulation in epigenetic signals, cellular messengers and molecular targets precedes pathological cardiac remodeling, disrupts progenitor cell functions, adversely affects the endogenous repair system, and metabolic pathways.
  • Hypoxia-inducible factor 1 (HIF-1) has been shown to be upregulated in HFrEF. This trasnscription activator is involved in various oxidation-reduction reactions, angiogenesis and vascular remodelling. Myocardial hypoxia leads to its activation which downstream produces elevated levels of brain natriuretic peptide (BNP). Hypoperfusion of peripheral organs leading to hypoxia is the key trigger for induction of increased HIF-1 activity.[1]

Protein kinase B signalling

MAPK cascade


Dysregulation of cellular protein metabolic pathways

Role of ERK1 and ERK2 pathways

Role of nitric oxide biosynthetic pathway

Smooth muscle cell proliferation

ATF2 mediated hypertrophy

Major biomarkers of HFrEF

NT-proBNP, GDF-15, and IL1RL1

  1. Casals G, Ros J, Sionis A, Davidson MM, Morales-Ruiz M, Jiménez W (August 2009). "Hypoxia induces B-type natriuretic peptide release in cell lines derived from human cardiomyocytes". Am. J. Physiol. Heart Circ. Physiol. 297 (2): H550–5. doi:10.1152/ajpheart.00250.2009. PMID 19542490.