Congestive heart failure treatment of underlying causes
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) 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