Management of Severe Heart Failure

Shinya Hiramitsu; Kenji Miyagishima; Hisashi Kimura; Kazumasa Mori; Kenji Shiino; Akira Yamada; Shigeru Kato; Yasuchika Kato; Shin-ichiro Morimoto; Hitoshi Hishida; Yukio Ozaki

doi:10.1253/circj.CJ-08-1106

Critical Care

Management of Severe Heart Failure

Shinya Hiramitsu, Kenji Miyagishima, Hisashi Kimura, Kazumasa Mori, Kenji Shiino, Akira Yamada, Shigeru Kato, Yasuchika Kato, Shin-ichiro Morimoto, Hitoshi Hishida, Yukio Ozaki

Author information

Shinya Hiramitsu
Cardiology, Hiramitsu Heart Clinic
Kenji Miyagishima
Division of Cardiology, Department of Internal Medicine, Fujita Health University, School of Medicine
Hisashi Kimura
Division of Cardiology, Department of Internal Medicine, Fujita Health University, School of Medicine
Kazumasa Mori
Division of Cardiology, Department of Internal Medicine, Fujita Health University, School of Medicine
Kenji Shiino
Division of Cardiology, Department of Internal Medicine, Fujita Health University, School of Medicine
Akira Yamada
Division of Cardiology, Department of Internal Medicine, Fujita Health University, School of Medicine
Shigeru Kato
Division of Cardiology, Department of Internal Medicine, Fujita Health University, School of Medicine
Yasuchika Kato
Division of Cardiology, Department of Internal Medicine, Fujita Health University, School of Medicine
Shin-ichiro Morimoto
Division of Cardiology, Department of Internal Medicine, Fujita Health University, School of Medicine
Hitoshi Hishida
Division of Cardiology, Department of Internal Medicine, Fujita Health University, School of Medicine
Yukio Ozaki
Division of Cardiology, Department of Internal Medicine, Fujita Health University, School of Medicine

Keywords: Acute heart failure, Chronic heart failure, Dilated cardiomyopathy, End-stage heart failure, Heart transplantation

JOURNAL FREE ACCESS

2009 Volume 73 Issue SupplementA Pages A36-A41

DOI https://doi.org/10.1253/circj.CJ-08-1106

View "Advance Publication" version (May 28, 2009).

Details

Abstract

Patients admitted to the hospital with heart failure (HF) include those with new-onset of acute HF and those with acute exacerbation of chronic HF (CHF). In therapy for new-onset acute HF associated with acute myocardial infarction, therapy to inhibit left ventricular (LV) remodeling in the convalescent phase is required in addition to that needed to overcome the acute phase. Hitherto, CHF therapy was aimed at improving LV contractability, whereas more recently the aim has shifted to resting the heart. Most patients with HF should be routinely managed with a combination of 3 types of drugs: a diuretic; an angiotensin converting enzyme inhibitor and/or an angiotensin II receptor blocker; and a β-blocker. The administration of β-blockers is of particular importance. For HF unresponsive to medical therapy, non-pharmacological therapies are considered. When a HF patient fails to respond to all available therapies, heart transplantation becomes necessary. Of the 1,000 HF patients admitted to our hospital, two cases received heart transplants. 11 cases were indicated for heart transplantation but died before registration. It should be remembered that although in Japan the possibility of receiving a heart transplant is very low, it is by no means entirely impossible. (Circ J 2009; Suppl A: A-36-A-41)

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