Pharmacologic therapies across the continuum of left ventricular dysfunction

Neurohormonal activation and increased sympathetic stimulation are among the factors that have been linked to the development and progression of left ventricular dysfunction (LVD) and heart failure (HF) in post-myocardial infarction (MI) patients. Various available pharmacologic therapies can target these factors and improve many aspects of the disease, depending on the degree of LVD. The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and aldosterone antagonists because of their proven favorable effects on symptoms, left ventricular function, cardiac remodeling, hospitalization rates, and survival. However, they are not being used in over two thirds of patients with post-MI LVD. This review illustrates the impact of these therapies on post-MI LVD patients using evidence from multiple clinical trials. In addition, current and emerging treatments for acute decompensated HF will be outlined. (C) 2008 Elsevier Inc. All rights reserved.