Medical Treatment of Heart Failure and Coronary Heart Disease

Abstract

Heart failure (HF) is a physiologic state in which the heart either cannot pump enough blood to meet the metabolic needs of the body or requires an elevated filling pressure to meet these needs. Coronary artery disease (CAD) is a common cause of HF, and the progression of CAD to HF can vary from abrupt cardiogenic shock after acute myocardial infarction to the insidious development of left ventricular failure in patients with chronic coronary heart disease. In cases of acute HF, treatment may include revascularization, correcting any reversible causes, various medications, and mechanical circulatory support. Treating chronic HF involves the up-titration of multiple oral medications that are often commenced in the hospital, with a view to achieving long-term clinical stability and a stable outpatient volume status. Chronic heart failure care also involves managing many comorbidities, including arrhythmias, which are common in the heart failure population. Managing these patients long-term involves the application of defibrillator therapies, timing the initiation of mechanical circulatory support therapies, and considering heart transplantation or palliative care strategies in selected patients.