Nesiritide should be considered for patients presenting with acutely typical or useful decompensated heart failure, especially those with dyspnea at rest or with minimal activity. [ncbi.nlm.nih.gov]

MHS, Associate Professor, Duke Clinical Research Institute, presented the results during a late-breaking clinical trial presentation during the Scientific Sessions of the American Heart Association. [cardiobrief.org]

Presented by Dr. Adrian Hernandez at the American Heart Association Scientific Sessions, Chicago, IL, November 14, 2010. [acc.org]

Medical experts say the results, presented Sunday at the American Heart Association meeting, show there is a lesson to be learned about the effectiveness of small studies over all. [nytimes.com]

• Intravenous Administration

  As a peptide, nesiritide has poor bioavailability and therefore is only available for intravenous administration. With a short half-life of less than 20 minutes, it is administered as a continuous infusion following a bolus injection. [cvpharmacology.com]

  A meta-analysis of five randomized studies with 1269 ADHF patients has demonstrated that intravenous administration of nesiritide significantly increase the risk of WRF and may cause renal toxicity [ 6 ]. [journals.plos.org]

• Intravenous Drugs

  Here is the AHA press rel ease: Large study of patients with severe heart failure confirms nesiritide safe, but shows no significant benefit on symptoms or mortality In a large clinical trial of the intravenous drug nesiritide in severe heart failure, [cardiobrief.org]

• Hemoptysis

  Adverse reactions CNS: dizziness, headache, insomnia, anxiety CV: hypotension, angina pectoris, bradycardia, ventricular extrasystole, ventricular tachycardia GI: nausea, vomiting, abdominal pain Musculoskeletal: leg cramps, back pain Respiratory: cough, hemoptysis [medical-dictionary.thefreedictionary.com]

  Respiratory: Cough, hemoptysis, apnea. Skin: Sweating, pruritus, rash. Special Senses: Amblyopia. Renal: Renal failure in acutely decompensated heart failure patients. Drug: No interaction trials conducted. [robholland.com]

• Orthopnea

  All-Cause Mortality [ Time Frame: Randomization to hospital discharge (up to Day 30) ] Clinical manifestations of worsening or persistent decompensated heart failure were defined by at least one of the following: new, persistent or worsening: dyspnea, orthopnea [clinicaltrials.gov]

• Abnormal Breathing

  Among other measures, the trial was designed to evaluate the change from baseline in pulmonary capillary wedge pressure (PCWP) and the change from baseline in subjects' dyspnea (abnormal breathing), evaluated after three hours. [centerwatch.com]

• Abdominal Pain

  pain catheter-related pain headache nausea does not interact with enalapril interactions with IV vasodilators (including IV ACE inhibitors) and other cardiovascular drugs have not been formally studied bolus of 2 mcg/kg followed by infusion of 0.01 mcg [aic.cuhk.edu.hk]

  Adverse reactions CNS: dizziness, headache, insomnia, anxiety CV: hypotension, angina pectoris, bradycardia, ventricular extrasystole, ventricular tachycardia GI: nausea, vomiting, abdominal pain Musculoskeletal: leg cramps, back pain Respiratory: cough [medical-dictionary.thefreedictionary.com]

  • Body as a Whole : Headache, abdominal pain and back pain. • Heart : Low blood pressure, fast/slow heart rate and chest pain. • Central Nervous System : Sleeplessness, dizziness, drowsiness and anxiety. • Gastrointestinal : Nausea and vomiting. [medindia.net]

  GI: Abdominal pain, nausea, vomiting. Respiratory: Cough, hemoptysis, apnea. Skin: Sweating, pruritus, rash. Special Senses: Amblyopia. Renal: Renal failure in acutely decompensated heart failure patients. Drug: No interaction trials conducted. [robholland.com]

  pain Back pain Insomnia Dizziness Anxiety Nausea Vomiting Mechanism of Action Human BNP binds to the particulate guanylate cyclase receptor of vascular smooth muscle and endothelial cells, leading to increased intracellular concentrations of guanosine [centerwatch.com]

• Hypotension

  Notify physician immediately if systolic BP Establish hypotension parameters prior to initiating therapy. Reduce the dose or withhold the drug if hypotension occurs during administration. [robholland.com]

  Adverse effects Hypotension, ventricular tachycardia, headache, nausea, back pain, decreased renal function. [medical-dictionary.thefreedictionary.com]

  […] usually resolves spontaneously or responds to fluid challenge of 250 ml or less duration of episode longer than hypotensive episodes associated with glyceryl trinitrate not proarrhythmic Non-cardiovascular Less common than with glyceryl trinitrate general [aic.cuhk.edu.hk]

  Interactions: Hypotension potentiated by ARBs and/or ACE inhibitors. Adverse Reactions: Hypotension, headache, nausea, back pain, dizziness; hypersensitivity. How Supplied: Single-use vials—1 [empr.com]

  While there was no increase in 30-day mortality or renal failure with nesiritide, the incidence of hypotension, including symptomatic hypotension, was higher with nesiritide. [acc.org]

• Orthostatic Hypotension

  hypotensive activities of Nesiritide. [drugbank.ca]

• Palpitations

  • Instruct patient to report chest pain, dizziness, palpitations, and other uncomfortable symptoms. • As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests [medical-dictionary.thefreedictionary.com]

• Sweating

  Skin: Sweating, pruritus, rash. Special Senses: Amblyopia. Renal: Renal failure in acutely decompensated heart failure patients. Drug: No interaction trials conducted. No clinically significant interactions reported. Onset: 15 min. [robholland.com]

• Pruritus

  Skin: Sweating, pruritus, rash. Special Senses: Amblyopia. Renal: Renal failure in acutely decompensated heart failure patients. Drug: No interaction trials conducted. No clinically significant interactions reported. Onset: 15 min. [robholland.com]

• Leg Cramp

  Adverse reactions CNS: dizziness, headache, insomnia, anxiety CV: hypotension, angina pectoris, bradycardia, ventricular extrasystole, ventricular tachycardia GI: nausea, vomiting, abdominal pain Musculoskeletal: leg cramps, back pain Respiratory: cough [medical-dictionary.thefreedictionary.com]

  Body as a Whole: Headache, back pain, catheter pain, fever, injection site pain, leg cramps. CNS: Insomnia, dizziness, anxiety, confusion, paresthesia, somnolence, tremor. [robholland.com]

• Insomnia

  Adverse reactions CNS: dizziness, headache, insomnia, anxiety CV: hypotension, angina pectoris, bradycardia, ventricular extrasystole, ventricular tachycardia GI: nausea, vomiting, abdominal pain Musculoskeletal: leg cramps, back pain Respiratory: cough [medical-dictionary.thefreedictionary.com]

  CNS: Insomnia, dizziness, anxiety, confusion, paresthesia, somnolence, tremor. CV: Hypotension, ventricular tachycardia, ventricular extrasystoles, angina, bradycardia, tachycardia, atrial fibrillation, AV node conduction abnormalities. [robholland.com]

  Natrecor infusion in clinical trials include (but are not limited to) the following: Hypotension Ventricular tachycardia (abnormally fast heart rate) Angina pectoris (chest pain) Bradycardia (abnormally slow heart rate) Headache Abdominal pain Back pain Insomnia [centerwatch.com]

• Paresthesia

  CNS: Insomnia, dizziness, anxiety, confusion, paresthesia, somnolence, tremor. CV: Hypotension, ventricular tachycardia, ventricular extrasystoles, angina, bradycardia, tachycardia, atrial fibrillation, AV node conduction abnormalities. [robholland.com]

• Hemoglobin Decreased

  Hematocrit, hemoglobin: decreased values Patient monitoring • Monitor vital signs and pulmonary artery wedge pressure continuously during and for several hours after infusion. • Assess cardiovascular status closely. [medical-dictionary.thefreedictionary.com]

Acute Heart Failure (AHF) 1 2 Completed Treatment Congestive Heart Failure (CHF) 2 2 Completed Treatment Congestive Heart Failure (CHF) / Impaired Renal Function 1 2 Completed Treatment Heart Failure 1 2 Recruiting Treatment Diastolic Dysfunction / Type [drugbank.ca]

[…] with standard care. 1, 2, 5 However, nesiritide may cause renal function to worsen and may increase the risk of death within 30 days. 3 Patients should be notified about the potential risks of treatment; nesiritide is not indicated for serial treatments [aafp.org]

Currently ACEI and BB represent the cornerstone of HF treatment. [cardio-debate.com]

[…] the current FDA indication for intravenous treatment of patients with acutely decompensated CHF who have dyspnea at rest or with minimal activity. [cms.gov]

But when nesiritide was approved by the Food and Drug Administration (FDA) in 2001, it was designated for the treatment of acute, decompensated congestive heart failure. [nejm.org]

[…] predicts outcome in patients with heart failure 13–17 and in those after infarction. 10,18,19 In parallel with the prognostic importance of the presence of renal dysfunction, worsening renal function immediately after coronary bypass portends a worse prognosis [circ.ahajournals.org]

All in all there has been no convincing beneficial effect on prognosis, and the use of this agent is mainly limited to the relief of dyspnea in the hospitalized HF patient with normal blood pressure. [cardio-debate.com]

B-Type natriuretic peptide (BNP) 1 and N-terminal proBNP (NT-proBNP) are now being used to confirm the diagnosis and, in some studies, to aid in the assessment of prognosis in patients with heart failure. [clinchem.aaccjnls.org]

There were no clinical characteristic differences between infusion responders and nonresponder patients in etiology of heart failure, left ventricular ejection fraction, presence of biventricular failure, estimated GFR, serum potassium and sodium, body [clinchem.aaccjnls.org]

VMAC would accept patients who required hospitalization and had heart failure with shortness of breath regardless of etiology or ventricular function. [clinicalleader.com]

Renal dysfunction in patients with heart failure with preserved versus reduced ejection fraction impact of the new chronic kidney disease-epidemiology collaboration group formula. [journals.plos.org]

Monash University, and Department of Epidemiology and Preventive Medicine, Alfred Hospital, Prahan, VIC, Australia (H.K.); Vilnius University Hospital, Santariskiu Klinikos, Department of Cardiology and Angiology, Vilnius, Lithuania (A.L.); University [nejm.org]

Natriuretic peptides in the pathophysiology of congestive heart failure. Curr Cardiol Rep 2000;2:198–205. Google Scholar 4. Zellner C, Protter AA, Ko E, et al. [link.springer.com]

Renal insufficiency may increase risk of heart failure progression, and the pathophysiology of renal dysfunction during the process of heart failure is complex. [bmjopen.bmj.com]

1243 Percutaneous Coronary Intervention 1258 Percutaneous Cardiac Procedures 1273 Coronary Artery Bypass Surgery 1290 Approaches to the Patient with Prior Bypass Surgery 1306 Percutaneous Valve Dilatations 1316 Global Pandemic of Heart Failure 1330 Pathophysiology [books.google.com]

Pathophysiologically, nesiritide not only could directly influence the glomerular arterioles, mesangial cells and renal tubules to improve renal function, but also could indirectly regulate the systemic hemodynamics, renin-angiotensin-aldosterone axis [journals.plos.org]

Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. ‏ [books.google.com]

Acute Myocardial Infarction (AMI) 1 2 Completed Prevention Cardiopulmonary Bypass / Congestive Heart Failure (CHF) / Coronary Artery Bypass Graft Surgery Patients / Coronary Heart Disease (CHD) / Ischaemic Heart Diseases 1 2 Completed Prevention Renal [drugbank.ca]

Prevent sodium and water resorption by inhibiting aldosterone secretion Diuresis results, which decreases preload, or the left ventricular end-volume, and the work of the heart Examples: lisinopril, enalapril, fosinopril, quinapril, captopril, ramipril [quizlet.com]

Moreover, they stated that a large, multi-center, prospective RCT is needed to evaluate the therapeutic potential of ANP or BNP in preventing and treating AKI in the cardiovascular surgical setting. [aetna.com]