Treatment of congestive heart failure -: Guidelines for the primary care physician and the heart failure specialist

被引:48
作者
Gomberg-Maitland, M [1 ]
Baran, DA [1 ]
Fuster, V [1 ]
机构
[1] CUNY, Mt Sinai Med Ctr, Zena & Michael A Wiener Cardiovasc Inst, Dept Cardiol, New York, NY 10029 USA
关键词
D O I
10.1001/archinte.161.3.342
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
During the past 10 years, the philosophy of heart failure treatment has evolved from symptom control to a combined prevention and symptom-management strategy. Recent clinical trials have proved that early detection can delay progression. Treatment of asymptomatic left ventricular dysfunction is as important as treatment of symptomatic disease. The purpose of this review is to simplify recent guidelines for pharmacological management of chronic systolic heart failure for the primary care physician and the heart failure specialist. Early recognition and prevention therapies, combined with lifestyle modification, are essential in the treatment of heart Failure. Therapy with angiotensin-converting enzyme inhibitors, beta -blockers, and diuretics is now standard. Digoxin is added to improve clinical symptoms, especially in patients with atrial fibrillation. Aldosterone antagonists may be recommended in select patients with stable New York Heart Association class III or IV heart failure. If angiotensin-converting enzyme inhibitors are not tolerated, angiotensin receptor blockers, hydralazine hydrochloride, and isosorbide dinitrate are recommended. The data on antiarrhythmic and anticoagulation therapies are inconclusive.
引用
收藏
页码:342 / 352
页数:11
相关论文
共 121 条
[61]   Clinical effects of β-adrenergic blockade in chronic heart failure -: A meta-analysis of double-blind, placebo-controlled, randomized trials [J].
Lechat, P ;
Packer, M ;
Chalon, S ;
Cucherat, M ;
Arab, T ;
Boissel, JP .
CIRCULATION, 1998, 98 (12) :1184-1191
[62]   ELEVATED CIRCULATING LEVELS OF TUMOR-NECROSIS-FACTOR IN SEVERE CHRONIC HEART-FAILURE [J].
LEVINE, B ;
KALMAN, J ;
MAYER, L ;
FILLIT, HM ;
PACKER, M .
NEW ENGLAND JOURNAL OF MEDICINE, 1990, 323 (04) :236-241
[63]  
Lindenfeld J, 1997, J AM COLL CARDIOL, V30, P1417
[64]   DIASTOLIC DYSFUNCTION AS A CAUSE OF HEART-FAILURE [J].
LITWIN, SE ;
GROSSMAN, W .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1993, 22 (04) :A49-A55
[65]  
Liu Y, 1995, LAB INVEST, V73, P771
[66]  
MacMahon S, 1997, LANCET, V349, P375
[67]  
Mann D L, 1996, J Card Fail, V2, pS165, DOI 10.1016/S1071-9164(96)80073-X
[68]   ADRENERGIC EFFECTS ON THE BIOLOGY OF THE ADULT MAMMALIAN CARDIOCYTE [J].
MANN, DL ;
KENT, RL ;
PARSONS, B ;
COOPER, G .
CIRCULATION, 1992, 85 (02) :790-804
[69]  
MASSIE B, 1988, AM J MED, V83, P75
[70]   Evolving trends in the epidemiologic factors of heart failure: Rationale for preventive strategies and comprehensive disease management [J].
Massie, BM ;
Shah, NB .
AMERICAN HEART JOURNAL, 1997, 133 (06) :703-712