Acute heart failure: vasoactive agents – does it matter?

Abstract

Acute heart failure (AHF) is defined as the rapid onset of symptoms se­ condary to abnormal cardiac function. It is a syndrome and has a va­ riety of potential etiologies. AHF is a very polymorphic conception and can be related with abnormalities in cardiac rhythm, systolic or diastolic dysfunction or preload and afterload mismatch. The cornerstone of ma­ nagement includes therapy directed towards the underlying cause of heart failure. On the other hand, if the underlying cause is irreversible  –  a heart assist device or even heart transplantation may be needed. Therefore, while awaiting their availability, vital organ perfusion remains crucial. In these settings, intravenous cardio-/vaso- active agents are necessary. With few exceptions, most vasopressor and positive inotropic agents are symphatomimetic amines that exert their action by binding and sti­ mulating adrenergic receptors. They are powerful drugs with a considerable potential for toxicity. Vasopressor and inotropic support in case of AHF helps to win the time until a more definitive treatment becomes available. Therefore, AHF management must be directed to establish and eliminate deteriorational factors, however, not the correction of particular hemodynamic parameters.