Congestive heart failure chronic pharmacotherapy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Assistant editor-in-chief Rim Halaby
Overview
There are several goals in the chronic management of systolic heart failure. The management of diastolic heart failure is discussed elsewhere. The first goal is to treat the patient's symptoms of heart failure and to improve the patient's exercise tolerance and quality of life. The use of diuretics and regular assessment of the patient's weight helps in avoiding excess body fluids that are associated with dyspnea and orthopnea. Another goal of the chronic treatment of heart failure is to decrease the rate of hospitalization and mortality. To achieve the second goal, patients with chronic heart failure should be administered an ACE inhibitor (or ARB if they are ACE intolerant) and a beta blocker. If the patient remains symptomatic, additional therapy may include an aldosterone antagonist.
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy (CRT) is recommended in congestive heart failure patients with:
- Symptoms: NYHA Class II-IV
- QRS: A prolonged QRS interval > 0.12
- LVEF: A LVEF < 30% to 35%
- Shown below is an image that summarizes the steps in the chronic management of patients with heart failure.