Dapagliflozine in the treatment of heart failure with reduce ejection fraction: case report

Detalhes bibliográficos
Autor(a) principal: Caldas, Marcia Azevedo
Data de Publicação: 2022
Outros Autores: Perez, Gabriel Barreto, Alexandre, Liliane Ferreira, Figueiredo, Marya Alice Sardinha
Tipo de documento: Artigo
Idioma: por
Título da fonte: Revista Científica da Faculdade de Medicina de Campos
Texto Completo: https://www.fmc.br/ojs/index.php/RCFMC/article/view/586
Resumo: Heart failure (HF) is the common end of several heart diseases, with great socioeconomic impact in Brazil andworldwide. To report the clinical improvement of the associationof dapaglifozin to the traditional therapeutic regimen of a patient with HF with reduced ejection fraction(HFpEFr) with difficult clinical control during hospitalization. A 63 year old woman, hypertensive, diabetic, with chronic kidney disease, coronary artery disease and peripheral disease, admitted with functional class IV HF(NYHA) - dyspnea on minimal effort, orthopnea, paroxysmal nocturnal dyspnea and edema of the lower limbs. On admission she presented with BP 130x80mmHg, RCR 3t (B3), HR 89bpm, mitral systolic murmur +2/6, pulmonary bibasilar crackles. Echocardiographic findings showed significant LV systolic dysfunction due to diffuse hypokinesia with EF of 18%. During hospitalization, despite therapeutic optimization, the patient didn't present functional classimprovement, with the need at times to reduce the dose of diuretics and vasodilators due to deterioration of renal function. Dapagliflozin 10 mg was associated to the therapeutic scheme and a daily adjustment of the othermedications was made. The following days were marked by clinical improvement of symptoms, and the patient was discharged on the 23rd day of hospitalization in functional class II. The clinical control of ICFEr, despite allthe available therapeutic arsenal, is still a challenge for many experienced specialists. The clinical evolution ofthe patient in question is in line with the main findings described in the DAPAHF and DAPA-CKD studies, whichdemonstrated a lower risk of worsening of HF or death from cardiovascular causes and reduced risk of worsening of renal function and death from renal or cardiovascular causes, respectively. By using dapagliflozin, the patient showed clinical improvement after failed attempts at conventional drug treatments.
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spelling Dapagliflozine in the treatment of heart failure with reduce ejection fraction: case reportDapagliflozina no tratamento da insuficiência cardíaca com fração de ejeção reduzida: relato de casoDapagliflozinaDoença rena crônicaInsuficiência cardíacaChronic Kidney DiseaseDapagliflozinHeart FailureHeart failure (HF) is the common end of several heart diseases, with great socioeconomic impact in Brazil andworldwide. To report the clinical improvement of the associationof dapaglifozin to the traditional therapeutic regimen of a patient with HF with reduced ejection fraction(HFpEFr) with difficult clinical control during hospitalization. A 63 year old woman, hypertensive, diabetic, with chronic kidney disease, coronary artery disease and peripheral disease, admitted with functional class IV HF(NYHA) - dyspnea on minimal effort, orthopnea, paroxysmal nocturnal dyspnea and edema of the lower limbs. On admission she presented with BP 130x80mmHg, RCR 3t (B3), HR 89bpm, mitral systolic murmur +2/6, pulmonary bibasilar crackles. Echocardiographic findings showed significant LV systolic dysfunction due to diffuse hypokinesia with EF of 18%. During hospitalization, despite therapeutic optimization, the patient didn't present functional classimprovement, with the need at times to reduce the dose of diuretics and vasodilators due to deterioration of renal function. Dapagliflozin 10 mg was associated to the therapeutic scheme and a daily adjustment of the othermedications was made. The following days were marked by clinical improvement of symptoms, and the patient was discharged on the 23rd day of hospitalization in functional class II. The clinical control of ICFEr, despite allthe available therapeutic arsenal, is still a challenge for many experienced specialists. The clinical evolution ofthe patient in question is in line with the main findings described in the DAPAHF and DAPA-CKD studies, whichdemonstrated a lower risk of worsening of HF or death from cardiovascular causes and reduced risk of worsening of renal function and death from renal or cardiovascular causes, respectively. By using dapagliflozin, the patient showed clinical improvement after failed attempts at conventional drug treatments.A Insuficiência cardíaca (IC) é via final comum de várias cardiopatias, com grande impacto socioeconômico no Brasil e no mundo. O objetivo do presente trabalho é relatar a melhora clínica da associação da dapaglifozina ao esquema terapêutico tradicional de paciente com ICcom fração de ejeção reduzida (ICFEr) de difícil controle clínico durante internação hospitalar. Trata-se de um relato de caso de Mulher, 63 anos, hipertensa, diabética, portadora de doença renal crônica, doença arterial coronária e periférica, internada com IC classe funcionalIV (NYHA) - dispneia aos mínimos esforços, ortopneia, dispneia paroxística noturna e edema de membros inferiores. Na admissão apresentava PA 130x80mmHg, RCR 3t (B3), FC 89bpm, sopro sistólico mitral +2/6, crepitações bibasais pulmonares. Os achados ecocardiográficosmostraram disfunção sistólica do VE de grau importante devido à hipocinesia difusa com FE de 18%. Durante a internação, apesar da otimização terapêutica, a paciente não apresentava melhora de classe funcional, havendo, em alguns momentos, necessidade de redução de dose de diuréticos e vasodilatadores por conta da deterioração da função renal. Foi associado Dapagliflozina 10 mg ao esquema terapêutico e realizado ajuste diário das demais medicações. Os dias que seguiram foram marcados por melhora clínica dos sintomas, recebendo alta no 23º dia de internação em classe funcional II. O controle clínico da ICFEr, apesar de todo o arsenal terapêutico disponível, ainda é um desafio para muitos especialistas com grande experiência. A evolução clínica da paciente em questão vem ao encontro dos principais achados descritos nos estudos DAPAHF e DAPA-CKD, que demonstraram menor risco de agravamento da IC ou morte por causas cardiovasculares e redução do risco de agravamento da função renal e de morte por causa renal ou cardiovascular respectivamente. Ao utilizar a Dapagliflozina, a paciente apresentou melhora clínica, após tentativas fracassadas de tratamentos com fármacos convencionais.Faculdade de Medicina de Campos (FMC)2022-12-30info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://www.fmc.br/ojs/index.php/RCFMC/article/view/58610.29184/1980-7813.rcfmc.586.vol.17.n2.2022Scientific Journal of the Medical School of Campos; Vol. 17 No. 2 (2022): Revista Científica da Faculdade de Medicina de Campos; 60-65Revista Científica da Faculdade de Medicina de Campos; v. 17 n. 2 (2022): Revista Científica da Faculdade de Medicina de Campos; 60-651980-7813reponame:Revista Científica da Faculdade de Medicina de Camposinstname:Faculdade de Medicina de Campos (FMC)instacron:FMCporhttps://www.fmc.br/ojs/index.php/RCFMC/article/view/586/328Copyright (c) 2022 Revista Científica da Faculdade de Medicina de Camposhttps://creativecommons.org/licenses/by-sa/4.0info:eu-repo/semantics/openAccessCaldas, Marcia AzevedoPerez, Gabriel BarretoAlexandre, Liliane FerreiraFigueiredo, Marya Alice Sardinha2022-12-30T20:33:02Zoai:ojs.www.fmc.br:article/586Revistahttps://www.fmc.br/ojs/index.php/RCFMC/PRIhttps://www.fmc.br/ojs/index.php/RCFMC/oai||revista@fmc.br1980-78131980-7813opendoar:2022-12-30T20:33:02Revista Científica da Faculdade de Medicina de Campos - Faculdade de Medicina de Campos (FMC)false
dc.title.none.fl_str_mv Dapagliflozine in the treatment of heart failure with reduce ejection fraction: case report
Dapagliflozina no tratamento da insuficiência cardíaca com fração de ejeção reduzida: relato de caso
title Dapagliflozine in the treatment of heart failure with reduce ejection fraction: case report
spellingShingle Dapagliflozine in the treatment of heart failure with reduce ejection fraction: case report
Caldas, Marcia Azevedo
Dapagliflozina
Doença rena crônica
Insuficiência cardíaca
Chronic Kidney Disease
Dapagliflozin
Heart Failure
title_short Dapagliflozine in the treatment of heart failure with reduce ejection fraction: case report
title_full Dapagliflozine in the treatment of heart failure with reduce ejection fraction: case report
title_fullStr Dapagliflozine in the treatment of heart failure with reduce ejection fraction: case report
title_full_unstemmed Dapagliflozine in the treatment of heart failure with reduce ejection fraction: case report
title_sort Dapagliflozine in the treatment of heart failure with reduce ejection fraction: case report
author Caldas, Marcia Azevedo
author_facet Caldas, Marcia Azevedo
Perez, Gabriel Barreto
Alexandre, Liliane Ferreira
Figueiredo, Marya Alice Sardinha
author_role author
author2 Perez, Gabriel Barreto
Alexandre, Liliane Ferreira
Figueiredo, Marya Alice Sardinha
author2_role author
author
author
dc.contributor.author.fl_str_mv Caldas, Marcia Azevedo
Perez, Gabriel Barreto
Alexandre, Liliane Ferreira
Figueiredo, Marya Alice Sardinha
dc.subject.por.fl_str_mv Dapagliflozina
Doença rena crônica
Insuficiência cardíaca
Chronic Kidney Disease
Dapagliflozin
Heart Failure
topic Dapagliflozina
Doença rena crônica
Insuficiência cardíaca
Chronic Kidney Disease
Dapagliflozin
Heart Failure
description Heart failure (HF) is the common end of several heart diseases, with great socioeconomic impact in Brazil andworldwide. To report the clinical improvement of the associationof dapaglifozin to the traditional therapeutic regimen of a patient with HF with reduced ejection fraction(HFpEFr) with difficult clinical control during hospitalization. A 63 year old woman, hypertensive, diabetic, with chronic kidney disease, coronary artery disease and peripheral disease, admitted with functional class IV HF(NYHA) - dyspnea on minimal effort, orthopnea, paroxysmal nocturnal dyspnea and edema of the lower limbs. On admission she presented with BP 130x80mmHg, RCR 3t (B3), HR 89bpm, mitral systolic murmur +2/6, pulmonary bibasilar crackles. Echocardiographic findings showed significant LV systolic dysfunction due to diffuse hypokinesia with EF of 18%. During hospitalization, despite therapeutic optimization, the patient didn't present functional classimprovement, with the need at times to reduce the dose of diuretics and vasodilators due to deterioration of renal function. Dapagliflozin 10 mg was associated to the therapeutic scheme and a daily adjustment of the othermedications was made. The following days were marked by clinical improvement of symptoms, and the patient was discharged on the 23rd day of hospitalization in functional class II. The clinical control of ICFEr, despite allthe available therapeutic arsenal, is still a challenge for many experienced specialists. The clinical evolution ofthe patient in question is in line with the main findings described in the DAPAHF and DAPA-CKD studies, whichdemonstrated a lower risk of worsening of HF or death from cardiovascular causes and reduced risk of worsening of renal function and death from renal or cardiovascular causes, respectively. By using dapagliflozin, the patient showed clinical improvement after failed attempts at conventional drug treatments.
publishDate 2022
dc.date.none.fl_str_mv 2022-12-30
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dc.identifier.uri.fl_str_mv https://www.fmc.br/ojs/index.php/RCFMC/article/view/586
10.29184/1980-7813.rcfmc.586.vol.17.n2.2022
url https://www.fmc.br/ojs/index.php/RCFMC/article/view/586
identifier_str_mv 10.29184/1980-7813.rcfmc.586.vol.17.n2.2022
dc.language.iso.fl_str_mv por
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dc.relation.none.fl_str_mv https://www.fmc.br/ojs/index.php/RCFMC/article/view/586/328
dc.rights.driver.fl_str_mv Copyright (c) 2022 Revista Científica da Faculdade de Medicina de Campos
https://creativecommons.org/licenses/by-sa/4.0
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Copyright (c) 2022 Revista Científica da Faculdade de Medicina de Campos
https://creativecommons.org/licenses/by-sa/4.0
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dc.publisher.none.fl_str_mv Faculdade de Medicina de Campos (FMC)
publisher.none.fl_str_mv Faculdade de Medicina de Campos (FMC)
dc.source.none.fl_str_mv Scientific Journal of the Medical School of Campos; Vol. 17 No. 2 (2022): Revista Científica da Faculdade de Medicina de Campos; 60-65
Revista Científica da Faculdade de Medicina de Campos; v. 17 n. 2 (2022): Revista Científica da Faculdade de Medicina de Campos; 60-65
1980-7813
reponame:Revista Científica da Faculdade de Medicina de Campos
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instname_str Faculdade de Medicina de Campos (FMC)
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reponame_str Revista Científica da Faculdade de Medicina de Campos
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repository.name.fl_str_mv Revista Científica da Faculdade de Medicina de Campos - Faculdade de Medicina de Campos (FMC)
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