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Treatments for Acute Decompensated Heart Failure

Acute decompensated heart failure (ADHF) is a common reason for respiratory failure. It is often caused by left ventricular dysfunction that might or might not be from other conditions, such as valve deformities or coronary artery disease. ADHF causes heart congestion, edema and low coronary output. More than 1 million people are hospitalized each year because of ADHF.

  1. Diuretics and Inotropes

    • Traditionally, cardiologists treat edema and heart congestion by prescribing a diuretic. A diuretic forces the kidneys to create more urine, thus removing excess fluids from the body. To treat low coronary output, doctors often prescribe an inotropic drug. Inotropes work on the cardiac muscle to increase the force of each heartbeat.

      Both therapies have drawbacks. Diuretics can cause low blood pressure, adverse changes to kidney function and imbalances to electrolyte levels. Inotropic drugs can increase the need for oxygen, when ADHF patients already struggle to get enough. Inotropes can restrict blood flow to the heart and disrupt regular heart beats, causing arrhythmia.

    Levosimendan

    • Levosimendan is a drug in the calcium sensitizers class, currently reserved as a second-line therapy for patients who failed to respond to inotropes and diuretics. Levosidmendan increases cardiac contractions and relaxes smooth muscle tissue in the heart to allow arteries to dilate for increased blood flow. It is administered through an IV. In multiple clinical trials, Levosimendan didn't produce the side effects associated with inotropes and diuretics.

    Ultrafiltration

    • Further study of ADHF led to the discovery that there is a link between hormones from the brain and heart failure. Doctors also discovered ADHF is a heterogeneous disorder (multiple reasons for the same illness), rather than attributable to one single defect or dysfunction. Some cardiologists are changing the way they treat ADHF based on this newer information. These doctors are using percutaneous (a process where internal organs are accessed via a needle inserted through the skin, such as an IV line into the heart) devices to improve renal function and cardiac output. Ultrafiltration is one such method. UF allows for greater fluid and sodium removal. Unlike renal dialysis, which works via diffusion, UF is based on convection and is less likely to cause metabolic disruption. Further studies are required before these methods will be implemented as the new first-line treatment.

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