Curr Probl Cardiol. 2018 Jul;43(7):294-304. doi: 10.1016/j.cpcardiol.2017.12.002. Epub 2017 Dec 16.
Decompensated or acute heart failure (AHF) is characterized by increased ventricular and atrial pressures which may lead to and be caused by circulatory congestion. Unless due to a primary decrease in cardiac function, congestion arises from volume expansion or vasoconstriction. In turn, volume expansion and vasoconstriction are due to neurohormonal imbalance since both result from activation of the sympathetic nervous system, the renin-angiotensin-aldosterone axis and excess secretion of arginine vasopressin. Outcomes in AHF remain dismal. Loop diuretics are the mainstay of therapy for AHF and may themselves aggravate neurohormonal imbalance. No adjunctive pharmacotherapy has yielded improvement in outcomes in AHF despite many attempts with various vasodilators and inotropes. We, therefore, propose that insufficient attention has been paid to neurohormonal imbalance in AHF. As in chronic HF, rectifying the effects of neurohormonal imbalance may lead to better outcomes. The use of alternative decongestive strategies or adjunctive pharmacotherapy directed at neurohormonal activation could yield benefit.
失代偿或急性心力衰竭（AHF）的特征是心室和心房压力增加，这可能导致和由循环充血引起。除非是由于心脏功能的原发性下降，充血是由于容量扩张或血管收缩引起的。反过来，容量扩张和血管收缩是由于神经激素失衡，因为两者都来自于交感神经系统、肾素-血管紧张素-醛固酮轴和精氨酸加压素过度分泌的激活。AHF 的结局仍然很糟糕。利尿剂是 AHF 治疗的主要方法，它们本身也可能加重神经激素失衡。尽管许多尝试使用各种血管扩张剂和正性肌力药，但没有一种辅助药物治疗能改善 AHF 的结局。因此，我们认为在 AHF 中对神经激素失衡的关注不够。就像在慢性心力衰竭中一样，纠正神经激素失衡的影响可能会带来更好的结果。使用替代的充血策略或针对神经激素激活的辅助药物治疗可能会带来益处。
