Heart Failure : Clinical Problem and Management Issues - 10/02/13

Doi : 10.1016/j.pop.2012.11.010

John M. Nicklas, MD ^a,^⁎ , Barry E. Bleske, PharmD ^b, Richard Van Harrison, PhD ^c, Robert V. Hogikyan, MD, MPH ^d, Yeong Kwok, MD ^e, William E. Chavey, MD, MS ^f
^a Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, CVC Room 2391, 1600 East Medical Center Drive, Ann Arbor, MI 48109-5853, USA
^b Department of Clinical and Social Administrative Services, College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, MI 48109-1065, USA
^c Department of Medical Education, University of Michigan, G1103 Towsley Center, 1500 East Medical Center Drive SPC 5201, Ann Arbor, MI 48109-5201, USA
^d Department of Internal Medicine, Division of Geriatrics and Palliative Medicine, University of Michigan, 2215 Fuller Road, 11G, Ann Arbor, MI 48105, USA
^e Department of Internal Medicine, Division of General Medicine, University of Michigan, 4260 Plymouth Road, Ann Arbor, MI 48109, USA
^f Departments of Family Medicine and Emergency Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, L2003 Women’s SPC 5239, Ann Arbor, MI 48109, USA

Corresponding author.

Résumé

Heart failure (HF) often presents as dyspnea either with exertion and/or recumbency. Patients also experience dependent swelling and fatigue. Measurement of the left ventricular ejection fraction (LVEF) identifies HF patients who may respond to pharmacologic therapy and/or electrophysiologic device implantation. Angiotension converting enzyme inhibitors, beta blockers, and aldosterone inhibitors can significantly lower the mortality and morbidity of HF in patients with an LVEF less than 35%. Cardiac defibrillators and biventricular pacemakers can also improve outcomes in selected patients with a decreased LVEF. The authors provide a guide for therapeutic decisions based on the inclusion criteria of the major clinical trials.

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Keywords : Heart failure, Cardiomyopathy, Angiotensin converting enzyme inhibitor, Beta blocker, Aldosterone antagonist, Implantable cardiodefibrillator, Biventricular pacemaker

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