Newer concepts in the medical management of patients with congestive heart failure

Neal L. Weintraub, Bernard R. Chaitman

Research output: Contribution to journalReview article

9 Citations (Scopus)

Abstract

Congestive heart failure (CHF) remains a major cause of morbidity and mortality in the United States, especially among the elderly. Although an underlying disturbance in cardiac function can be identified in most patients, manifestations of the disease are greatly influenced by other factors, particularly neurohumoral and peripheral adaptive responses which occur secondary to impaired cardiac function. The renin‐angiotensin system (RAS) is integrally involved in the pathophysiology of CHF. Originally considered a humoral system, the RAS is now known to exist and operate within cardiac and vascular tissues. The importance of tissue‐specific renin‐angiotensin systems in CHF is presently under investigation. Most patients with symptomatic CHF benefit from the administration of an ACE inhibitor. Certain asymptomatic patients, such as those with severe left ventricular (LV) dysfunction and those who are at high risk for LV remodeling after anterior wall myocardial infarction, may also benefit from ACE inhibitor therapy. Diuretics and nitrates improve symptoms and often cardiac output in many patients with CHF. Although many new inotropic agents have been tested in CHF patients, none appear clinically superior to digitalis glycosides. The efficacy of digitalis glycosides in CHF may in part result from sympathoinhibitory properties such as the activation of baroreceptor mechanisms. Despite the fact that many CHF patients die from arrhythmias, treatment of asymptomatic ventricular arrhythmias in these patients is not recommended. Patients with symptomatic or sustained ventricular arrhythmias are best treated by a physician experienced in cardiac electrophysiology. Therapy with beta‐blocking drugs for CHF patients is controversial. Anticoagulants are recommended for selected patients with CHF. Finally, exercise therapy may improve functional capacity in some patients with CHF through its effects on peripheral blood vessels and skeletal muscle tissues.

Original languageEnglish (US)
Pages (from-to)380-390
Number of pages11
JournalClinical Cardiology
Volume16
Issue number5
DOIs
StatePublished - May 1993
Externally publishedYes

Fingerprint

Heart Failure
Digitalis Glycosides
Cardiac Arrhythmias
Angiotensin-Converting Enzyme Inhibitors
Blood Vessels
Cardiac Electrophysiology
Anterior Wall Myocardial Infarction
Exercise Therapy
Pressoreceptors
Ventricular Remodeling
Left Ventricular Dysfunction
Diuretics
Cardiac Output
Nitrates
Anticoagulants
Skeletal Muscle
Therapeutics
Morbidity
Physicians
Muscles

Keywords

  • ACE inhibitors
  • arrhythmias
  • diuretics
  • exercise therapy
  • inotropic agents
  • nitrates
  • renin‐angiotensin system (RAS)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Newer concepts in the medical management of patients with congestive heart failure. / Weintraub, Neal L.; Chaitman, Bernard R.

In: Clinical Cardiology, Vol. 16, No. 5, 05.1993, p. 380-390.

Research output: Contribution to journalReview article

@article{ee63543c41ea41139c6b2b8f23c66cad,
title = "Newer concepts in the medical management of patients with congestive heart failure",
abstract = "Congestive heart failure (CHF) remains a major cause of morbidity and mortality in the United States, especially among the elderly. Although an underlying disturbance in cardiac function can be identified in most patients, manifestations of the disease are greatly influenced by other factors, particularly neurohumoral and peripheral adaptive responses which occur secondary to impaired cardiac function. The renin‐angiotensin system (RAS) is integrally involved in the pathophysiology of CHF. Originally considered a humoral system, the RAS is now known to exist and operate within cardiac and vascular tissues. The importance of tissue‐specific renin‐angiotensin systems in CHF is presently under investigation. Most patients with symptomatic CHF benefit from the administration of an ACE inhibitor. Certain asymptomatic patients, such as those with severe left ventricular (LV) dysfunction and those who are at high risk for LV remodeling after anterior wall myocardial infarction, may also benefit from ACE inhibitor therapy. Diuretics and nitrates improve symptoms and often cardiac output in many patients with CHF. Although many new inotropic agents have been tested in CHF patients, none appear clinically superior to digitalis glycosides. The efficacy of digitalis glycosides in CHF may in part result from sympathoinhibitory properties such as the activation of baroreceptor mechanisms. Despite the fact that many CHF patients die from arrhythmias, treatment of asymptomatic ventricular arrhythmias in these patients is not recommended. Patients with symptomatic or sustained ventricular arrhythmias are best treated by a physician experienced in cardiac electrophysiology. Therapy with beta‐blocking drugs for CHF patients is controversial. Anticoagulants are recommended for selected patients with CHF. Finally, exercise therapy may improve functional capacity in some patients with CHF through its effects on peripheral blood vessels and skeletal muscle tissues.",
keywords = "ACE inhibitors, arrhythmias, diuretics, exercise therapy, inotropic agents, nitrates, renin‐angiotensin system (RAS)",
author = "Weintraub, {Neal L.} and Chaitman, {Bernard R.}",
year = "1993",
month = "5",
doi = "10.1002/clc.4960160504",
language = "English (US)",
volume = "16",
pages = "380--390",
journal = "Clinical Cardiology",
issn = "0160-9289",
publisher = "John Wiley and Sons Inc.",
number = "5",

}

TY - JOUR

T1 - Newer concepts in the medical management of patients with congestive heart failure

AU - Weintraub, Neal L.

AU - Chaitman, Bernard R.

PY - 1993/5

Y1 - 1993/5

N2 - Congestive heart failure (CHF) remains a major cause of morbidity and mortality in the United States, especially among the elderly. Although an underlying disturbance in cardiac function can be identified in most patients, manifestations of the disease are greatly influenced by other factors, particularly neurohumoral and peripheral adaptive responses which occur secondary to impaired cardiac function. The renin‐angiotensin system (RAS) is integrally involved in the pathophysiology of CHF. Originally considered a humoral system, the RAS is now known to exist and operate within cardiac and vascular tissues. The importance of tissue‐specific renin‐angiotensin systems in CHF is presently under investigation. Most patients with symptomatic CHF benefit from the administration of an ACE inhibitor. Certain asymptomatic patients, such as those with severe left ventricular (LV) dysfunction and those who are at high risk for LV remodeling after anterior wall myocardial infarction, may also benefit from ACE inhibitor therapy. Diuretics and nitrates improve symptoms and often cardiac output in many patients with CHF. Although many new inotropic agents have been tested in CHF patients, none appear clinically superior to digitalis glycosides. The efficacy of digitalis glycosides in CHF may in part result from sympathoinhibitory properties such as the activation of baroreceptor mechanisms. Despite the fact that many CHF patients die from arrhythmias, treatment of asymptomatic ventricular arrhythmias in these patients is not recommended. Patients with symptomatic or sustained ventricular arrhythmias are best treated by a physician experienced in cardiac electrophysiology. Therapy with beta‐blocking drugs for CHF patients is controversial. Anticoagulants are recommended for selected patients with CHF. Finally, exercise therapy may improve functional capacity in some patients with CHF through its effects on peripheral blood vessels and skeletal muscle tissues.

AB - Congestive heart failure (CHF) remains a major cause of morbidity and mortality in the United States, especially among the elderly. Although an underlying disturbance in cardiac function can be identified in most patients, manifestations of the disease are greatly influenced by other factors, particularly neurohumoral and peripheral adaptive responses which occur secondary to impaired cardiac function. The renin‐angiotensin system (RAS) is integrally involved in the pathophysiology of CHF. Originally considered a humoral system, the RAS is now known to exist and operate within cardiac and vascular tissues. The importance of tissue‐specific renin‐angiotensin systems in CHF is presently under investigation. Most patients with symptomatic CHF benefit from the administration of an ACE inhibitor. Certain asymptomatic patients, such as those with severe left ventricular (LV) dysfunction and those who are at high risk for LV remodeling after anterior wall myocardial infarction, may also benefit from ACE inhibitor therapy. Diuretics and nitrates improve symptoms and often cardiac output in many patients with CHF. Although many new inotropic agents have been tested in CHF patients, none appear clinically superior to digitalis glycosides. The efficacy of digitalis glycosides in CHF may in part result from sympathoinhibitory properties such as the activation of baroreceptor mechanisms. Despite the fact that many CHF patients die from arrhythmias, treatment of asymptomatic ventricular arrhythmias in these patients is not recommended. Patients with symptomatic or sustained ventricular arrhythmias are best treated by a physician experienced in cardiac electrophysiology. Therapy with beta‐blocking drugs for CHF patients is controversial. Anticoagulants are recommended for selected patients with CHF. Finally, exercise therapy may improve functional capacity in some patients with CHF through its effects on peripheral blood vessels and skeletal muscle tissues.

KW - ACE inhibitors

KW - arrhythmias

KW - diuretics

KW - exercise therapy

KW - inotropic agents

KW - nitrates

KW - renin‐angiotensin system (RAS)

UR - http://www.scopus.com/inward/record.url?scp=0027212452&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027212452&partnerID=8YFLogxK

U2 - 10.1002/clc.4960160504

DO - 10.1002/clc.4960160504

M3 - Review article

C2 - 8504571

AN - SCOPUS:0027212452

VL - 16

SP - 380

EP - 390

JO - Clinical Cardiology

JF - Clinical Cardiology

SN - 0160-9289

IS - 5

ER -