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DOI: 10.1016/j.rceng.2019.02.013
Available online 4 May 2019
Residual congestion and clinical intuition in decompensated heart failure
La congestión residual y la intuición clínica en la insuficiencia cardiaca descompensada
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J.I. Pérez Calvoa,b,c,
Corresponding author
jiperez@unizar.es

Corresponding author.
, J. Rubio Graciaa,c, C. Josa Laordena,c, J.L. Morales Rulld,e
a Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
b Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain
c Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
d Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, Spain
e Instituto de Investigación Biomédica Dr. Pifarré, Lleida, Spain
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Received 03 January 2019. Accepted 19 February 2019
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Tables (2)
Table 1. Performance of the various techniques for determining the degree of congestion.
Table 2. Congestion assessment using clinical scores.
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Abstract

Congestive symptoms are the key to recognizing decompensated heart failure, whose treatment is based on reducing the congestion until a clinical situation has been reached that allows the patient to be discharged to continue outpatient treatment. The important aspect is not the degree of congestion at admission but rather the congestion that persists after energetic diuretic therapy. The persistence of congestive signs following an apparently correct and effective therapy has been called residual congestion and is associated with a poor prognosis. The tools for determining this condition are still rudimentary. Methods therefore need to be developed that enable a more accurate assessment.

Keywords:
Heart failure
Congestion
Residual congestion
Diuretic therapy
Resumen

Los síntomas congestivos son la clave para reconocer las descompensaciones de la insuficiencia cardiaca. Su tratamiento se basa en la reducción de la congestión hasta alcanzar una situación clínica que permita el alta del paciente para continuar el tratamiento ambulatoriamente. Lo importante, no obstante, no es el grado de congestión al ingreso, sino la que persiste después de un tratamiento diurético enérgico. A la persistencia de signos congestivos después de un tratamiento aparentemente correcto y eficaz, se le ha denominado «congestión residual» y se asocia con mal pronóstico. Las herramientas para su estimación son todavía rudimentarias, por lo que deben desarrollarse métodos que permitan una valoración más precisa.

Palabras clave:
Insuficiencia cardiaca
Congestión
Congestión residual
Terapia diurética

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