Overview
Left ventricular failure (LV failure) occurs when the left ventricle cannot pump blood efficiently, leading to symptoms such as dyspnea, fatigue, and fluid retention. It often results from underlying conditions like ischemic heart disease, valvular disorders, or cardiomyopathy.Diagnosis
Clinical Symptoms: Dyspnea, fatigue, peripheral edema 1.
Hemodynamic Monitoring: Elevated left ventricular end-diastolic pressure (LVEDP) and reduced cardiac output 134.
Imaging: Echocardiography to assess ventricular function and size 1.
Electrocardiogram (ECG): May show signs of ischemia or arrhythmias 5.
Lung Function Tests: Assess for coexisting bronchial hyperresponsiveness 2.Management
Inotropic Support: Dobutamine and Corwin (beta-1 adrenergic agonists) increase cardiac output and reduce LVEDP 4.
- Dobutamine: 5-10 μg/kg/min i.v.
- Corwin: 0.025-0.10 mg/kg i.v.
Mechanical Support: Implantable rotary blood pumps regulated by physiological control mechanisms to emulate Frank-Starling mechanism 1.
Ventilation Strategies: Positive end-expiratory pressure (PEEP) can maintain cardiac output in acute LV failure by reducing preload sensitivity 3.
Antiarrhythmic Agents: Melperone can improve hemodynamic parameters without adverse metabolic effects 5.
- Melperone: 1.0 and 2.5 mg/kg i.v. (cumulative dose)Special Populations
Elderly: Increased risk of arterial stiffness affecting hemodynamic responses (e.g., PEEP effects) 36.
Comorbidities: Bronchial hyperresponsiveness may coexist with LV failure, requiring careful management of respiratory symptoms 2.Key Recommendations
Utilize inotropic agents like dobutamine or Corwin to enhance cardiac output and alleviate LVEDP in acute LV failure (Evidence: Moderate) 4.
Consider mechanical circulatory support devices with physiological control mechanisms to manage severe LV failure (Evidence: Weak) 1.
Apply PEEP cautiously in acute LV failure to maintain cardiac output without exacerbating myocardial ischemia (Evidence: Moderate) 3.
Monitor and manage coexisting bronchial hyperresponsiveness in patients with LV failure through appropriate respiratory support (Evidence: Moderate) 2.
Evaluate and treat elderly patients with consideration for altered arterial compliance impacting hemodynamic responses (Evidence: Expert opinion) 36.References
1 Bakouri MA, Salamonsen RF, Savkin AV, AlOmari AH, Lim E, Lovell NH. A sliding mode-based starling-like controller for implantable rotary blood pumps. Artificial organs 2014. link
2 Pison C, Malo JL, Rouleau JL, Chalaoui J, Ghezzo H, Malo J. Bronchial hyperresponsiveness to inhaled methacholine in subjects with chronic left heart failure at a time of exacerbation and after increasing diuretic therapy. Chest 1989. link
3 Hevrøy O, Reikerås O, Grundnes O, Mjøs OD. Cardiovascular effects of positive end-expiratory pressure during acute left ventricular failure in dogs. Clinical physiology (Oxford, England) 1988. link
4 Vik-Mo H, Yasay G, Maroko PR, Ribeiro LG. Comparative effects of dobutamine and corwin, a beta 1-adrenergic partial agonist, in experimental left ventricular failure. Journal of cardiovascular pharmacology 1985. link
5 Smiseth OA, Platou ES, Refsum H, Mjøs OD. Haemodynamic and metabolic effects of the antiarrhythmic drug melperone during acute left ventricular failure in dogs. Cardiovascular research 1981. link
6 Merillon JP, Motte G, Aumont MC, Masquet C, Lecarpentier Y, Gourgon R. Post-extrasystolic left ventricular peak pressure with and without left ventricular failure. Cardiovascular research 1979. link