Congestive heart failure treatment of underlying causes

Congestive Heart Failure Microchapters
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Acute Pharmacotherapy
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Chronic Pharmacotherapy in HFrEF Diuretics ACE Inhibitors Angiotensin receptor blockers Aldosterone Antagonists Beta Blockers Ca Channel Blockers Nitrates Hydralazine Positive Inotropics Anticoagulants Angiotensin Receptor-Neprilysin Inhibitor Antiarrhythmic Drugs Nutritional Supplements Hormonal Therapies Drugs to Avoid Drug Interactions Treatment of underlying causes Associated conditions
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Surgical Therapy: Biventricular Pacing or Cardiac Resynchronization Therapy (CRT) Implantation of Intracardiac Defibrillator Ultrafiltration Cardiac Surgery Left Ventricular Assist Devices (LVADs) Cardiac Transplantation
ACC/AHA Guideline Recommendations Initial and Serial Evaluation of the HF Patient Hospitalized Patient Patients With a Prior MI Sudden Cardiac Death Prevention Surgical/Percutaneous/Transcather Interventional Treatments of HF Patients at high risk for developing heart failure (Stage A) Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B) Patients with current or prior symptoms of heart failure (Stage C) Patients with refractory end-stage heart failure (Stage D) Coordinating Care for Patients With Chronic HF Quality Metrics/Performance Measures
Implementation of Practice Guidelines
Congestive heart failure end-of-life considerations
Specific Groups: Special Populations Patients who have concomitant disorders Obstructive Sleep Apnea in the Patient with CHF NSTEMI with Heart Failure and Cardiogenic Shock
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Treatment of the underlying cause of heart failure including ischemic heart disease, hypertension, renovascular disease, or valvular heart disease is critical in the management of the patient with congestive heart failure.

Ischemic Heart Disease

Underlying ischemic heart disease is the most common cause of chronic congestive heart failure and is the underlying cause of heart failure in 50% to 75% of patients. Ischemic heart disease results in systolic dysfunction of the heart due to irreversible damage of the left ventricle if there has been a prior MI. There can also be viable tissue that is stunned or hibernating as a cause of heart failure. The management of these patients consists of risk factor modification (for example with the use of statins or beta blockers ) as well as the relief of angina (for example with the use of nitrates ). Revascularization (percuataneous coronary intervention or coronary artery bypass grafting) is indicated in the following scenarios:

• To improve symptoms.
• To improve prognosis. If there is a perfusion defect, revascularization may improve prognosis.
• To prevent recurrent heart failure decompensation. If the patient has repeated episodes of congestive heart failure decompensation, revascularization may be indicated.

Hypertension

Hypertension is a common underlying cause of congestive heart failure. There are 2 goals in the treatment of the congestive heart failure patient with hypertension:

1. Reduce the preload and

2. Reduce the afterload

The following agents improve survival in the heart failure patient and are the preferred antihypertensive agents:

• Beta blockers
• Angiotensin-converting enzyme inhibitors
• Angiotensin receptor blockers in patients who cannot tolerate a angiotensin converting enzyme inhibitor
• Aldosterone antagonists

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