Nursing Practice for a Case of Acute Left Heart Failure Complicated with Colonic Impaction

Research Background: Heart failure is a type of organic heart disease caused by excessive ventricular load, leading to insufficient myocardial contractility and decreased cardiac output in the body. With the progression of the patient's condition, gastrointestinal dysfunction is frequently complicated. At the same time, the accumulation of feces in the body (colonic impaction) can also increase the burden on the patient’s heart, triggering or exacerbating the occurrence or progression of heart failure. Purpose: this article focuses on the correlation between colonic impaction and heart failure, using the nursing experience of a case of acute left heart failure complicated by colonic impaction as an example, in order to provide clinical evidence for the care of patients with colonic impaction combined with heart failure in the future. Method: By using innovative thinking, the stomach tube is used to replace the enema tube, which is inserted through the anus to reach the end of the colon. By combining acupressure at points such as Zhongwan, Tianzhu, and Guanyuan, it helps promote the elimination of fecal impaction. Conclusion: This case reflects the innovative thinking and adaptability of nurses, providing a new clinical approach for the aggravation of the condition of long-term heart failure patients due to constipation issues. Further research in clinical practice is warranted.

Evaluating the Effectiveness of Emergency Ventilator Treatment for Severe Acute Left Ventricular Heart Failure

Objective:To evaluate the efficacy of emergency ventilator therapy in severe acute left heart failure.Methods:A total of 75 patients with severe acute left ventricular heart failure who were admitted to the hospital from July 2020 to July 2023 were randomly divided into two groups.Group A received additional emergency ventilator treatment,and group B received conventional treatment.The efficacy was compared.Results:The curative effect of patients with severe acute left heart failure in group A was higher than that in group B(P<0.05);all blood gas indicators in group A were better than those in group B(P<0.05);all vital signs indicators in group A were better than those in group B(P<0.05);group A was more satisfied with the treatment of severe acute left ventricular heart failure than group B(P<0.05).Conclusion:Patients with severe acute left heart failure who receive emergency ventilator treatment can stabilize vital signs,improve blood oxygen supply,and enhance curative effect.

Systematic review on the risk-benefit ratio of morphine for acute heart failure

Objective:To evaluate morphine's risk-benefit profile in the treatment of acute heart failure.Method:Different electronic databases,including PubMed,MEDLINE,Cochrane Library,and Google Scholar,as well as clinicaltrails.gov,were searched for articles published between 2012 and 2022.The risk of bias in the present study was evaluated by employing randomized controlled trials(RCTs)checklist that assesses the effectiveness of new interventions through random assignment of participants to different treatment groups.The two-part tool was used to address the five specific domains such as selection bias,performance bias,detection bias,attrition bias,and selective reporting bias.Evaluation of the quality of diagnostic accuracy studies was conducted using the RevMan software(version 5.4),a quality assessment tool.Results:A total of 13 studies were included in the present review,in which there were 5 retrospective studies,3 randomized-control studies,2 prospective studies,1 multicenter pharmacodynamics study,1 multicenter cardiac magnetic resonance imaging study,and 1 open-label,cross-over study.The mortality of acute heart failure patients treated with morphine was higher compared to those without morphine.Conclusions:Acute heart failure patients who do not receive morphine have a lower mortality rate compared to those who receive morphine.Considering the adverse effects,including mortality associated with morphine,there is a pressing need for further research to explore alternative and effective treatment options in acute heart failure.

Pediatric acute heart failure caused by endocardial fibroelastosis mimicking dilated cardiomyopathy:A case report

BACKGROUND Endocardial fibroelastosis(EFE)is a diffuse endocardial collagen and elastin hyperplasia disease of unknown etiology,which may be accompanied by myocardial degenerative changes leading to acute or chronic heart failure.However,acute heart failure(AHF)without obvious associated triggers is rare.Prior to the report of endomyocardial biopsy,the diagnosis and treatment of EFE are highly susceptible to being confounded with other primary cardiomyopathies.Here,we report a case of pediatric AHF caused by EFE mimicking dilated cardiomyopathy(DCM),with the aim of providing a valuable reference for clinicians to early identify and diagnose EFE-induced AHF.CASE SUMMARY A 13-mo-old female child was admitted to hospital with retching.Chest X-ray demonstrated enhanced texture in both lungs and an enlarged heart shadow.Color doppler echocardiography showed an enlarged left heart with ventricular wall hypokinesis and decreased left heart function.Abdominal color ultrasonography revealed a markedly enlarged liver.Pending the result of the endomyocardial biopsy report,the child was treated with a variety of resuscitative measures including nasal cannula for oxygen,intramuscular sedation with chlorpromazine and promethazine,cedilanid for cardiac contractility enhancement,and diuretic treatment with furosemide.Subsequently,the child’s endomyocardial biopsy report result was confirmed as EFE.After the above early interventions,the child’s condition gradually stabilized and improved.One week later,the child was discharged.During a 9-mo follow-up period,the child took intermittent low-dose oral digoxin with no signs of recurrence or exacerbation of the heart failure.CONCLUSION Our report suggests that EFE-induced pediatric AHF may present in children over 1 year of age without any apparent precipitants,and that the associated clinical presentations are grossly similar to that of pediatric DCM.Nonetheless,it is still possible to be diagnosed effectively on the basis of the comprehensive analysis of auxiliary inspection findings before the result of the endomyocardial biopsy is reported.

Clinical Study of Intermittent Levosimendan in the Treatment of Acute Heart Failure

[Objectives] To investigate the clinical efficacy of intermittent levosimendan in the treatment of acute heart failure. [Methods] 100 patients diagnosed with acute heart failure and hospitalized in the internal medicine-cardiovascular department in The First People s Hospital of Yulin from January 2019 to February 2020 were randomly divided into two groups, 50 cases in each group. Both groups were treated with conventional anti-heart failure drugs. The control group was given levosimendan once, and the observation group was given levosimendan three times, with an interval of one month. The creatinine (Cr) level, serum NT proBNP, left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LVEDD) were observed at 48 h before and after treatment and one month and two months after treatment in both groups. [Results] Compared with before treatment, the levels of NT-proBNP decreased in the two groups at 48 h after treatment, and the difference was statistically significant ( P <0.05). The Cr level of the control group did not change significantly before and after treatment, and the Cr level of the observation group decreased at one and two months after treatment compared with before treatment, with statistically significant differences ( P <0.05). Compared with before treatment, NT-proBNP and LVEDD decreased and LVEF increased at one and two months after treatment, and the differences were statistically significant ( P <0.05). There were no obvious adverse reactions in the two groups of patients during the treatment. [Conclusions] Repetitive use of levosimendan in the treatment of acute heart failure could significantly improve the renal function, cardiac contractility and cardiac function of patients, and with the passage of time, the treatment effect was improved, which is worthy of clinical promotion.

Clinical impact of portal vein pulsatility on the prognosis of hospitalized patients with acute heart failure

BACKGROUND Heart failure(HF)causes extracardiac organ congestion,including in the hepatic portal system.Reducing venous congestion is essential for HF treatment,but evaluating venous congestion is sometimes difficult in patients with chronic HF.The portal vein(PV)flow pattern can be influenced by right atrial pressure.Ultrasound images of the PV are quite easy to obtain and are reproducible among sonographers.However,the association between PV pulsatility and the condition of HF remains unclear.We hypothesize that PV pulsatility at discharge reflects the condition of HF.AIM To evaluate the usefulness of PV pulsatility as a prognostic marker for hospit-alized patients with acute HF.METHODS This observational study was conducted from April 2016 to January 2017 and April 2018 to April 2019 at Shinko Hospital.We enrolled 56 patients with acute HF,and 17 patients without HF served as controls.PV flow velocity was mea-sured by ultrasonography on admission and at discharge.We calculated the PV pulsatility ratio(PVPR)as the ratio of the difference between the peak and minimum velocity to the peak velocity.The primary endpoint was cardiac death and HF re-hospitalization.The observation period was 1 year from the first hospitalization.The Kaplan-Meier method was used to determine the stratified composite event-free rates,and the log-rank test was used for comparisons between groups.RESULTS On admission,the PVPR was significantly higher in patients with acute HF than controls(HF:0.29±0.20 vs controls:0.08±0.07,P<0.01).However,the PVPR was significantly decreased after the improvement in HF(admission:0.29±0.20 vs discharge:0.18±0.15,P<0.01)due to the increase in minimum velocity(admission:12.6±4.5 vs discharge:14.6±4.6 cm/s,P=0.03).To elucidate the association between the PVPR and cardiovascular outcomes,the patients were divided into three groups according to the PVPR tertile at discharge(PVPR-T1:0≤PVPR≤0.08,PVPR-T2:0.08<PVPR≤0.21,PVPR-T3:PVPR>0.21).The Kaplan-Meier analysis showed that patients with a higher PVPR at discharge had the worst prognosis among the groups.CONCLUSION PVPR at discharge reflects the condition of HF.It is also a novel prognostic marker for hospitalized patients with acute HF.

Acute heart failure as an adverse event of tumor necrosis factor inhibitor therapy in inflammatory bowel disease:A review of the literature

Tumor necrosis factor inhibitors(anti-TNFs)are widely used therapies for the treatment of inflammatory bowel diseases(IBD);however,their administration is not risk-free.Heart failure(HF),although rare,is a potential adverse event related to administration of these medications.However,the exact mechanism of development of HF remains obscure.TNFαis found in both healthy and damaged hearts.Its effects are concentration-and receptor-dependent,promoting either cardio-protection or cardiomyocyte apoptosis.Experimental rat models with TNFαreceptor knockout showed increased survival rates,less reactive oxygen species formation,and improved diastolic left ventricle pressure.However,clinical trials employing anti-TNF therapy to treat HF had disappointing results,suggesting abolishment of the cardioprotective properties of TNFα,making cardiomyocytes susceptible to apoptosis and oxidation.Thus,patients with IBD who have risk factors should be screened for HF before initiating anti-TNF therapy.This review aims to discuss adverse events associated with the administration of anti-TNF therapy,with a focus on HF,and propose some approaches to avoid cardiac adverse events in patients with IBD.

Infective bicuspid aortic valve endocarditis causing acute severe regurgitation and heart failure:A case report

BACKGROUND Infective endocarditis(IE)is an uncommon but potentially life-threatening infection,which occasionally develops into acute severe valve insufficiency leading to the onset of heart failure,and necessitates timely intervention.However,the variable and atypical clinical manifestations always make the early detection of IE difficult and challenging.CASE SUMMARY A 45-year-old female who was previously healthy presented with exertional shortness of breath and paroxysmal nocturnal dyspnea.She also suffered from a significant decrease in exercise capacity,whereas her body temperature was normal.She had severe hypoxemia and hypotension along with a marked aortic valve murmur.Diffuse pulmonary edema and bilateral pleural effusion were observed on both chest X-ray and computed tomography scan.Transthoracic echocardiography was performed immediately and revealed severe regurgitation of the bicuspid aortic valve.Transesophageal echocardiography was further performed and vegetations were detected.In addition to adequate medical therapy and ventilation support,the patient underwent urgent and successful aortic valve replacement.Her symptoms were significantly relieved and the postoperative chest X-ray showed that pulmonary edema was significantly reduced.Histopathology of the resected valve and positive microorganism culture of the surgical specimen provided evidence of definite IE.CONCLUSION IE should be considered in critical patients with refractory heart failure caused by severe bicuspid aortic valve regurgitation.

Role of Ultrasound Lung Comets in the Diagnosis of Acute Heart Failure in Emergency Department: A Systematic Review and Meta-analysis

Objective A new technique of transthoracic lung ultrasonography(TLS) has emerged and demonstrated promising results in acute heart failure diagnosis at an early stage. However, the diagnostic value of ultrasound lung comets(ULCs) for acute heart failure(AHF) performed in busy emergency department(ED) is uncertain. The present meta-analysis aimed to assess the diagnostic efficiency of ULCs in AHF. Methods We conducted a search on online journal databases to collect the data on TLS performed for diagnosing AHF published up to the end of July 2017. The sensitivity, specificity, positive likelihood ratio(PLR), negative likelihood ratio(NLR), and summary receiver operating characteristic(SROC) curve were calculated. The post-test probability of AHF was calculated by using Bayes analysis. Results We enrolled a total of 15 studies involving 3,309 patients. The value of sensitivity, specificity, PLR, NLR, DOR, area under the SROC curve, and Q* index was 85%, 91%, 8.94, 0.14, 67.24, 0.9587, and 0.9026, respectively. We detected significant heterogeneity among included studies, and therefore, all these results were analyzed under the random-effect model. We also explored possible sources of heterogeneity among the studies by using meta-regression analysis. Results suggest that the time interval between patient’s admission to bedside TLS examination was closely related to TLS accuracy. Conclusion This meta-analysis demonstrated that detecting ULCs is a convenient bedside tool and has high accuracy for early AHF diagnosis in ED. TLS could be recommended to be applied for early diagnosis of AHF in ED.

Is oxygen therapy beneficial for normoxemic patients with acute heart failure?A propensity score matched study

Background:The clinical efficiency of routine oxygen therapy is uncertain in patients with acute heart failure(AHF)who do not have hypoxemia.The aim of this study was to investigate the association between oxygen therapy and clinical outcomes in normoxemic patients hospitalized with AHF using real-world data.Methods:Normoxemic patients diagnosed with AHF on intensive care unit(ICU)admission from the electronic ICU(eICU)Collaborative Research Database were included in the current study,in which the study population was divided into the oxygen therapy group and the ambient air group.Propensity score matching(PSM)was applied to create a balanced covariate distribution between patients receiving supplemental oxygen and those exposed to ambient air.Linear regression and logistic regression models were performed to assess the associations between oxygen therapy and length of stay(LOS),and all-cause in-hospital as well as ICU mortality rates,respectively.A series of sensitivity and subgroup analyses were conducted to further validate the robustness of our findings.Results:A total of 2922 normoxemic patients with AHF were finally included in the analysis.Overall,42.1%(1230/2922)patients were exposed to oxygen therapy,and 57.9%(1692/2922)patients did not receive oxygen therapy(defined as the ambient air group).After PSM analysis,1122 pairs of patients were matched:each patient receiving oxygen therapy was matched with a patient without receiving supplemental oxygen.The multivariable logistic model showed that there was no significant interaction between the ambient air and oxygen therapy for all-cause in-hospital mortality[odds ratio(OR)=1.30;95%confidence interval(CI)0.92–1.82;P=0.138]or ICU mortality(OR=1.39;95%CI 0.83–2.32;P=0.206)in the post-PSM cohorts.In addition,linear regression analysis revealed that oxygen therapy was associated with prolonged ICU LOS(OR=1.11;95%CI 1.06–1.15;P<0.001)and hospital LOS(OR=1.06;95%CI 1.01–1.10;P=0.009)after PSM.Furthermore,the absence of an effect of supplemental oxygen on mortality was consistent in all subgroups.Conclusions:Routine use of supplemental oxygen in AHF patients without hypoxemia was not found to reduce all cause in-hospital mortality or ICU mortality.

Effect of ivabradine in the treatment of acute exacerbation of chronic obstructive pulmonary disease with heart failure

Objective: To observe the effectiveness and safety of ivabradine in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and heart failure. Methods:Patients who were admitted to hospital with AECOPD during the period from August 2017 to July 2018. Then those both had heart failure with reduced ejection fraction(HFrEF) and a resting heart rate>70 beats/min were enrolled. A total of 86 cases were screened and completed, which were randomly divided into two groups for treatment. The control group(41 cases) received standard treatments, such as oxygen, anti-infection, anti-spasmodic, hormone, diuretic, ACEI/ARB, recombinant human brain natriuretic peptide (rhBNP), etc. The bisoprolol was given 2.5~5 mg orally once a day to control heart rate, and the test group(45 cases) was further treated with ivabradine 2.5~5 mg orally twice a day on the basis of the control group. The average heart rate, cardiac function, lung function, and 6-minute walking test were compared between the two groups. Results: After treatment, the average heart rate of the test group was lower than the control group, and the heart rate control rate(<70 beats/min%) of the test group was superior to the control group. The level of N-terminal B-type natriuretic peptide(NT-proBNP) in test group was significantly lower than that in control group. The distance of the 6-minute walking test in e test group was significantly longer than that in control group. Conclusion: Ivabradine combined with bisoprolol could help patients with AECOPD and heart failure to further reduce the heart rates, improve heart function and exercise tolerance. Moreover, the therapeutic safety was acceptable during the short term.

Clinical study of recombinant human brain natriuretic peptide in patients with acute myocardial infarction complicating congestive heart failure

Objectives To observe the efficacy and safety of recombinant human brain natriuretic peptide(rh-BNP) on patients with acute myocardial infarction complicating congestive heart failure.Methods 40 patients with acute myocardial infarction complicated by congestive heart failure were randomly divided into control group and treatment group of 20 cases.The control group,15 cases of acute anterior myocardial infarction,5 cases of acute inferior wall myocardial infarction, 15 males and 5 females,aged 55-70 years,mean age 58±12 years;treated 16 cases of acute anterior myocardial infarction,4 cases of acute myocardial infarction,16 males and 4 females,aged 56-70 years,mean age 59±11 years;two groups of age,gender,severity of disease and vascular lesions no significant difference and comparable(P】0.05).Conventional group were given aspirin,clopidogrel, statins,Inotropic,diuretic and vasodilator therapy.In the con- ventional treatment group based on the use of recombinant human brain natriuretic peptide(new bios,Tibet Pharmaceutical Co.,Ltd.Chengdu Nuodikang biopharmaceutical production, usage:1.5μg/Kg intravenous injection(impact), then 0.0075μg-0.01μg/(kg·min)infusion rate).Continuous medication 72 h.The clinical symptoms observed for 3 days in patients before treatment and after treatment,heart rate,blood pressure and left ventricular ejection fraction (LVEF) and tumor necrosis factor(TNF-α),brain natriuretic peptide(BNP) levels were measured.Results In control group,8 cases markedly effect,5 cases effect and 7 cases no effect,the total effective rate was 65%;In treatment group,13 cases markedly effect,6 cases effect and 1 cases no effect,the total effective rate was 95%,compared with two groups P New bios treatment group significantly increased cardiac index(CI) in patients with heart failure and left ventricular ejection fraction(LVEF) than the control group(all P【0.05),further reduce the levels of tumor necrosis (TNF-α) and brain natriuretic peptide(BNP).Conclusions rh-BNP can improve symptoms and heart function,reduced plasma tumor necrosis factor(TNF-α) and BNP levels of acute myocardial infarction patients with congestive heart failure,the treatment safe and reliable.As small sample size observed,larger sample to be accumulated to further evaluate its efficacy and safety.

FACE-HF: Focused Assessment by Chest Sonography and Echocardiography in Acute Heart Failure Patients

Background: Acute heart failure (AHF) is a life-threatening condition that necessitates urgent evaluation and treatment with an urgent need for hospital admission. Among the available imaging modalities, echocardiography is the method of choice due to its feasibility and cost-effectiveness. Lung ultrasonography in emergency department, critical and cardiac care units is becoming popular. The present study aimed to assess the value of the focused echocardiography and lung ultrasound protocol for guiding treatment and its effect on the hospitalization period in AHF patients admitted to the CCU, 6 months re-hospitalization and mortality. Methods: This study included 40 consecutive patients admitted to the Cardiology and Angiology department after disposition from the emergency department at Alexandria main university hospital in Egypt with the diagnosis of (AHF). Patients were divided into 2 groups, 20 patients received the standard treatment while the other group received a modification of medication doses according to daily imaging changes. All patients were followed up for 6 months to assess the 6 months HF rehospitalization and death rates. Results: Group II patients had a significantly shorter duration of hospitalization;6.45 ± 2.01 days compared to 9.10 ± 3.82 days among group I patients (P = 0.02). There was no significant difference between the two groups regarding the 6 months rehospitalization and death rates. Conclusion: The focused echocardiography and lung ultrasound-guided therapy for AHF patients resulted in a shorter duration of hospitalization without increased adverse events.

Correlation of Ceruloplasmin with Biomarkers of Cardiac Remodelling and Myofibrosis in Patients with Acute Decompensated Heart Failure Referred to a Tertiary Nurse Lead Heart Failure Clinic

Background: Ceruloplasmin is an acute phase protein with plasma copper binding properties, and is a potent extracellular antioxidative enzyme. Inflammation and oxidative stress might explain the role of ceruloplasmin in the pathophysiology of heart failure. Study objective: The objective is to assess the correlation of ceruloplasmin levels with biomarkers of cardiac remodelling and myofibrosis in patients with acute decompensated heart failure. Patients and methods: Blood samples were taken and serum levels of soluble ST2, galectin-3, NT-proBNP and ceruloplasmin were analysed in 31 consecutive patients with systolic HF referred to tertiary care nurse lead heart failure clinic with acute decompensated CHF requiring i.v. diuretics. The mean patients’ age was 68 years, mean left ventricular ejection fraction (LV EF) was 29%, 66% patients had ischemic aetilogy of CHF and 33% had atrial fibrillation. Results: The mean ceruloplasmin level was 0.243 g/l, mean galectin-3 level was 1.26 ng/ml, mean sST2 level was 38.15 ng/ml, and mean NT-proBNP was 1927 pg/ml. The ceruloplasmin level correlated with NT-proBNP (r = 0.58, p < 0.05) and with sST2 (r = 0.77, p < 0.001), sST2 levels correlated significantly with NT-proBNP (r = 0.66, p < 0.01). The ceruloplasmin level did not correlate with galectin-3 concentration. Conclusion: The ceruloplasmin level correlates with the biomarkers of cardiac remodelling (NT-proBNP, sST2), but not with the biomarker of myofibrosis (galectin-3). This finding supports the hypothesis of inflammatory response in acute decompensated heart failure.

Congestive heart failure masquerading as acute abdomen:A case report

Rationale:As an uncommon manifestation of congestive heart failure,congestive hepatopathy requires an early diagnosis in order to render appropriate care.Misdiagnosis as intraabdominal sepsis may lead to erroneous initial intervention,such as fluid boluses,that can potentially tip an already sick patient with poor reserves over into an extreme state.Patient’s Concern:A 65-year-old man was brought to the emergency department for excruciating abdominal pain,vomiting and jaundice.He also had lower limb pitting edema and was hypotensive en route.Diagnosis:Congestive hepatopathy.Interventions:Intravenous furosemide and fluid restriction.Outcomes:The patient declined admission to the cardiology ward and discharged himself against medical advice after his condition was improved in the emergency department.Lessons:It is important to pay attention to acute abdominal pain induced by extraabdominal pathologies.In this case of acute decompensated congestive heart failure,early recognition of the cause makes a difference to the management.

Effi cacy and Renal Tolerability of Ultrafi ltration in Acute Decompensated Heart Failure: A Meta-analysis and Systematic Review of 19 Randomized Controlled Trials

Background:Acute decompensated heart failure(ADHF)is a life-threatening and costly disease.Controversy re-mains regarding the effi cacy and renal tolerability of ultrafi ltration for treating ADHF.We therefore performed this meta-analysis to evaluate this clinical issue.Methods:A search of PubMed,EMBASE,and the Cochrane database of controlled trials was performed from in-ception to March 2021 for relevant randomized controlled trials.The quality of the included trials and outcomes was evaluated with the use of the risk of bias assessment tool and the Grading of Recommendations,Assessment,Develop-ment and Evaluation(GRADE)approach,respectively.The risk ratio and the standardized mean difference(SMD)or weighted mean difference(WMD)were computed and pooled with fi xed-effects or random-effects models.Results:This meta-analysis included 19 studies involving 1281 patients.Ultrafi ltration was superior to the control treatments for weight loss(WMD 1.24 kg,95%confi dence interval[CI]0.38-2.09 kg,P=0.004)and fl uid removal(WMD 1.55 L,95%CI 0.51-2.59 l,P=0.003)and was associated with a signifi cant increase in serum creatinine level compared with the control treatments(SMD 0.15 mg/dL,95%CI 0.00-0.30 mg/dL,P=0.04).However,no signifi cant effects were found for serum N-terminal prohormone of brain natriuretic peptide level,length of hospital stay,all-cause mortality,or all-cause rehospitalization in the ultrafi ltration group.Conclusions:The use of ultrafi ltration in patients with ADHF is superior to the use of the control treatments for weight loss and fl uid removal,but has adverse renal effects and lacks signifi cant effects on long-term prognosis,in-dicating that this approach to decongestion in ADHF patients is effi cient for fl uid management but less safe renally.

Effects of rh BNP after PCI on non-invasive hemodynamic in acute myocardial infarction patients with left heart failure

Objective: To investigate the effects of exogenous recombinant human brain natriuretic peptide(rh BNP) after primary percutaneous coronary intervention(PCI) on non-invasive hemodynamic in acute myocardial infarction patients with left ventricular failure. Methods: A number of 96 acute myocardial infarction patients accompanied with heart failure after PCI hospitalized in the People's Hospital of Sanya during February 2012 to October 2015 were selected. They were randomly divided into the therapy group(n = 50) and control group(n = 46). On the basis of routine treatment, patients in the therapy group were treated with intravenous rh BNP(1.5 μg/kg was intravenous injection with uniform speed of 3 min, followed by continuous infusion 0.007 5 μg/kg·min for 72 h), while the control group received conventional treatment. Bio Z-2011 non-invasive hemodynamic real-time monitoring system was used to monitor the hemodynamic parameters changes and the leves of plasma pro-BNP, serum creatinine, serum potassium, serum sodium and urine volume of each group before and after treating for 30 min, 1 h, 3 h, 6 h, 12 h, 24 h, 48 h, 72 h. Results: Patients in the therapy group showed no effect on heart rate, while after 30 min of intravenous injection of rh BNP, CO, CI, SV, and SI increased significantly and LVET and TFC reduced at the same time, which had certain effect on blood pressure(SBP/DBP). Compared with the control group, the therapy group showed a faster and more effective improvement on haemodynamics. Conclusions: Acute myocardial infarction patients complicated with left heart failure after primary PCI can significantly improve hemodynamics by treating with rh BNP.

Predicting mortality in patients with acute heart failure:Role of risk scores

Acute heart failure is a leading cause of hospitalization and death,and it is an increasing burden on health care systems. The correct risk stratification of patients could improve clinical outcome and resources allocation,avoiding the overtreatment of low-risk subjects or the early,inappropriate discharge of high-risk patients. Many clinical scores have been derived and validated for in-hospital and post-discharge survival; predictive models include demographic,clinical,hemodynamic and laboratory variables. Data sets are derived from public registries,clinical trials,and retrospective data. Most models show a good capacity to discriminate patients who reach major clinical end-points,with C-indices generally higher than 0.70,but their applicability in realworld populations has been seldom evaluated. No study has evaluated if the use of risk score-based stratification might improve patient outcome. Some variables(age,blood pressure,sodium concentration,renal function) recur in most scores and should always be considered when evaluating the risk of an individual patient hospitalized for acute heart failure. Future studies will evaluate the emerging role of plasma biomarkers.

Characteristics of Patients with Decreased Cognitive Function Undergoing Treatment for Acute Exacerbation of Chronic Heart Failure—Basic Survey for Standardization of Nursing to Prevent Discontinuation of Treatment

The purpose of this study is to clarify the characteristics of patients with decreased cognitive function undergoing treatment for acute exacerbation phase of chronic heart failure as a basic survey with a view to the standardization of nursing to prevent discontinuation of treatment of patients with declining cognitive function in the acute exacerbation phase of chronic heart failure. As the first stage of the research, using the interview guide created based on the background of discontinuation of treatment and symptomatic monitoring from 33 target literature sources, seven certified chronic heart failure nurses and 15 certified dementia nurses were given semi-structured interviews. Data obtained from the interviews was analyzed by qualitative induction. As a result, we obtained opinions/views on 8 situations namely, “cognitive function at hospitalization”, “characteristics at hospitalization, “characteristics when receiving examinations, procedures or treatment”, “characteristics of course of treatment”, “characteristics related to difficulties in grasping the symptoms of chronic heart failure and indices of deterioration”, “characteristics when using diuretics”, “characteristics concerning compliance with dietary restrictions” and “support required for discharge from hospital” concerning patients with declining cognitive function. In the future, it is necessary to prepare nursing protocols incorporating these contents for standardization of nursing.

Prognostic impact of atrial fibrillation on clinical outcomes of acute coronary syndromes,heart failure and chronic kidney disease

Atrial fibrillation(AF) is the most common type of sustained arrhythmia,which is now on course to reach epidemic proportions in the elderly population. AF is a commonly encountered comorbidity in patients with cardiac and major non-cardiac diseases. Morbidity and mortality associated with AF makes it a major healthcare burden. The objective of our article is to determine the prognostic impact of AF on acute coronary syndromes,heart failure and chronic kidney disease. Multiple studies have been conducted to determine if AF has an independent role in the overall mortality of such patients. Our review suggests that AF has an independent adverse prognostic impact on the clinical outcomes of acute coronary syndromes,heart failure and chronic kidney disease.