Wilfried Mullens Profile picture
Oct 11, 2022 10 tweets 6 min read Read on X
Tweetorial on #vasodilators for low-output #heartfailure
to improve hemodynamics which help to decongest better and allow introduction/uptitration of neurohumorel blockers.
(as addendum to ) (1/10)
Normal heart = preload dependent (2/10)
Vasodilator ⬇️ blood pressure in normal heart through reduction of preload (3/10)
Failing HFrEF = afterload dependent (4/10)
High afterload in failing HFrEF (not HFpEF) is also strongly determined by ⬆️ wall tension (not SVR) as ⬆️ R and ⬇️ wall thickness. SVR is an oversimplification of afterload. (5/10)
Vasodilator ⬆️ cardiac output in failing HFrEF through reduction of afterload often with =/⬆️ blood pressure
(6/10)
Nr 1 vasoactive agent to use in failing HFrEF (cold+wet) = nitroprusside with dose adjustment based upon MAP. Inotropes in this situation = medical error as they induce often "crash and burn scenario" (ie addition of vasopressors - MCS which should NOT have occurred).....(7/10)
See nitroprusside for low-output critical AS (surely afterload is not determined by SVR as AS is fixed resistance, but it's also wall tension) (8/10)
25 patient study in @NEJM pubmed.ncbi.nlm.nih.gov/12724481/
See nitroprusside for low-output decompensated HFrEF pubmed.ncbi.nlm.nih.gov/18617068/ (9/10)

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Wilfried Mullens

Wilfried Mullens Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @WilfriedMullens

Nov 5, 2022
Breaking News @AHAScience with #TRANSFORMHF - the largest (N=2859) ambulatory #heartfailure diuretic trial to determine if torsemide would be superior to furosemide to ⬇️ reduce all-cause mortality - what a huge accomplishment of @robmentz et al!!! (1/9)
sciencedirect.com/science/articl…
At first sight 'no need to transform your practice' as both are similarly effective for mortality (2/9)
Also similar for mortality and all-cause hospitalizations (3/9)
Read 9 tweets
Apr 27, 2022
Results of the randomized #ADVOR trial are soon coming your way! It's the largest diuretic trial in acute #heartfailure ever conducted (N=519) and will test acetazolamide on top of loop diuretics. Recruitment is finished and full database lock is anticipated. Find out more (1/9). Image
Appropriate and thorough decongestion is class I recommendation in HFA-ESC guidelines (2/9).
academic.oup.com/eurheartj/arti…
#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR #HeartFailure2022 #HFA_ESC Image
Only 15% of AHF included in DOSE trial were decongested after 72 hours of high-dose loop diuretic (LD) therapy (3/9).
nejm.org/doi/full/10.10… Image
Read 9 tweets
Apr 12, 2022
What to do if the eGFR drops from 50 to 42 ml/min/m2 during decongestive therapy in acute #HeartFailure ?
Short #Tweetorial on worsening renal function (WRF) (1/9).
#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR #HeartFailure2022 #HFA_ESC
There is an underappreciated risk of poor outcome in heart failure patients discharged with ongoing congestion and WRF (2/9).
Pivotal paper of @MarcoMetra ahajournals.org/doi/10.1161/ci…
Appropriate and thorough decongestion is class I recommendation in HFA-ESC guidelines so DON'T stop decongestive efforts during WRF (3/9).
academic.oup.com/eurheartj/arti…
Read 9 tweets
Mar 29, 2022
Which statement is correct with regards to the use of diuretics in #HeartFailure with congestion?

Short #Tweetorial on how to use diuretics in heart failure (1/9).

#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR #HeartFailure2022 #HFA_ESC
Door to ‘diuretic’ time: earlier administration of loop diuretics is associated with improved outcomes independent of HF severity (2/9).
jacc.org/doi/abs/10.101…
The first dose of the loop diuretic should be 40 mg furosemide (=1 mg bumetanide) in diuretic naïve and twice the home dose in patients on loop diuretic (3/9).
Read 9 tweets
Mar 8, 2022
1/10. Wat is the most important driver of worsening renal function in #HeartFailure ?

Look at #Tweetorial on central hemodynamic derangements in heart failure

#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR
2/10. The kidney is a remarkable vascular organ. Renal blood flow = 1000 ml/min, renal plasma flow = 600 ml/min.
3/10. Elevated central venous pressure affects renal function significantly more than reduced cardiac output in heart failure. jacc.org/doi/10.1016/j.…
Read 10 tweets
Feb 23, 2022
Tweet: renal sodium avidity in #HeartFailure

Do you ever wonder what is happening in the kidney in Heart Failure patients? Here’s a short #Tweetorial on renal physiology in HF (1/6).
#Cardiotwitter #Cardiology #FOAMed #Cardiorenal #MedEd #MedTwitter #Nephrology #ADVOR
Glomerulus: renal blood flow ↓ in HF, but the kidney tries to maintain GFR by afferent arteriolar vasodilation and efferent arteriolar vasoconstriction. This leads to single-nephron hyperfiltration initially preserving total GFR, but further damaging the glomerulus. (2/6)
Proximal tubules: hyperfiltration leads to ↑ water and solutes filtered, but ↓ remaining in the peritubular capillaries. Due to ↑ peritubular capillary oncotic pressure + ↑ renal lymph flow -> ↑ water and Na+ reabsorption in the proximal tubules (3/6)
Read 6 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us!

:(