Congestive heart failure treatment of underlying causes

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Congestive Heart Failure Microchapters


Patient Information


Historical Perspective



Systolic Dysfunction
Diastolic Dysfunction


Differentiating Congestive heart failure from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis


Clinical Assessment

History and Symptoms

Physical Examination

Laboratory Findings


Chest X Ray

Cardiac MRI


Exercise Stress Test

Myocardial Viability Studies

Cardiac Catheterization

Other Imaging Studies

Other Diagnostic Studies


Invasive Hemodynamic Monitoring

Medical Therapy:

Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Positive Inotropics
Angiotensin Receptor-Neprilysin Inhibitor
Antiarrhythmic Drugs
Nutritional Supplements
Hormonal Therapies
Drugs to Avoid
Drug Interactions
Treatment of underlying causes
Associated conditions

Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

Congestive heart failure treatment of underlying causes On the Web

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Risk calculators and risk factors for Congestive heart failure treatment of underlying causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Edzel Lorraine Co, DMD, MD[2]


Treatment of the underlying cause of heart failure including ischemic heart disease, hypertension, renovascular disease, or valvular heart disease is critical in the management of the patient with congestive heart failure.

Ischemic Heart Disease

Underlying ischemic heart disease is the most common cause of chronic congestive heart failure and is the underlying cause of heart failure in 50% to 75% of patients. [1]. Ischemic heart disease results in systolic dysfunction of the heart due to irreversible damage of the left ventricle if there has been a prior MI. There can also be viable tissue that is stunned or hibernating as a cause of heart failure. The management of these patients consists of risk factor modification (for example with the use of statins or beta blockers ) as well as the relief of angina (for example with the use of nitrates ). Revascularization (percuataneous coronary intervention or coronary artery bypass grafting) is indicated in the following scenarios:

2022 ACC/AHA/HFSA Heart Failure Guideline (DO NOT EDIT) [2]

Revascularization for CAD

Class I
"1. In selected patients with HF, reduced EF (EF ≤ 35%), and suitable coronary anatomy, surgical revascularization plus GDMT is beneficial to improve symptoms, cardiovascular hospitalizations, and long-term all-cause mortality. [3][4][5][6][7][8][9][10] (Level of Evidence: B-R) "


Hypertension is a common underlying cause of congestive heart failure. There are 2 goals in the treatment of the congestive heart failure patient with hypertension:

1. Reduce the preload and

2. Reduce the afterload

The following agents improve survival in the heart failure patient and are the preferred antihypertensive agents:

Patients with bilateral renal artery stenosis tend to have a greater risk of flash pulmonary edema than those patients with unilateral renal artery stenosis[11]. This combination of flash pulmonary edema and bilateral renal artery stenosis is known as Pickering syndrome[12]. Is not unreasonable for patients with recurrent flash pulmonary edema and renal artery stenosis to undergo revascularization. The data in support of this recommendation however is modest.

2022 AHA/ACC/HFSA Heart Failure Guidelines

Management of Hypertension

Class I
"1. In patients with HFrEF and hypertension, uptitration of GDMT to the maximally tolerated target dose is recommended. [13][14](Level of Evidence: C-LD) "

Valvular Heart Disease

In 10% to 12% of patients, valvular heart disease is the underlying cause of congestive heart failure. [15]. It should also be noted that as the heart dilates in the setting of heart failure, there is often secondary mitral regurgitation and tricuspid regurgitation in many patients with a dilated cardiomyopathy. Please consult of the chapters on either mitral regurgitation or aortic regurgitation regarding the treatment of valvular heart disease. In general, once the left ventricular systolic diameter begins to increase, mitral valve repair ( left ventricular end systolic diameter greater than 45 mm) or aortic valve replacement (left ventricular end systolic diameter greater than 55 mm) is often indicated.

2022 AHA/ACC/HFSA Heart Failure Guidelines (DO NOT EDIT) [2]

Valvular Heart Disease

Class I
"1. In patients with HF, VHD should be managed in a multidisciplinary manner in accordance with clinical practice guidelines for VHD to prevent worsening of HF and adverse clinical outcomes. [16][17][18][19][20][21][22][23][24][25][26] (Level of Evidence: B-R) "
"2. In patients with chronic severe secondary MR and HFrEF, optimization of GDMT is recommended before any intervention for secondary MR related to LV dysfunction. [18][19][20][27][28][29] (Level of Evidence: C-LD) "

Other Underlying Disorders That May Warrant Treatment

There are a variety of other systemic or cardiovascular disorders that may secondarily cause heart failure, and these primary disorders may warrant treatment as well:

External Link


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