Pathophysiology and Management Chronic Heart Failure

Abstract

Chronic heart failure refers to a clinical state of systemic and pulmonary congestion resulting from inability of the heart to pump as much blood as required for the adequate metabolism of the body. The commonest causes of heart failure are coronary artery disease, hypertension and diabetes, however, hypertension and diabetes have been found to be stronger risk factors in elderly women and coronary artery disease and smoking are stronger risk factors in elderly men. Pathophysiologically, heart failure is either an inadequate cardiac output for the organism’s metabolic demands or an adequate cardiac output that is due to neurohormonal compensation, which means the inability of the heart to supply blood to the tissues according to their needs without additional strain. The pharmacological treatment of chronic heart failure with reduced ejection fraction is now based on four classes of drugs that have been proven to reduce mortality among heart failure patients such as angiotensinogen converting enzyme inhibitors or angiotensin II receptor blockers, beta-blockers, aldosterone antagonists and sodium-glucose co-transporter 2 inhibitors. Angiotensinogen converting enzyme inhibitors or angiotensin II receptor blocker therapy should be initiated at a low dose with very gradual up titration, monitoring renal function and serum potassium levels closely. Chronic heart failure treatment with direct inhibitors of aldosterone receptors brought about a significant improvement in terms of survival and hospitalizations.