Treatment of Heart Failure with Abnormal Left Ventricular Systolic Function in Older Adults

Wilbert S Aronow

doi:10.1016/j.hfc.2017.02.004

Treatment of Heart Failure with Abnormal Left Ventricular Systolic Function in Older Adults

Heart Fail Clin. 2017 Jul;13(3):467-483. doi: 10.1016/j.hfc.2017.02.004.

Author

Wilbert S Aronow¹

Affiliation

¹ Division of Cardiology, Department of Medicine, Westchester Medical Center, New York Medical College, Macy Pavilion, Room 141, Valhalla, NY 10595, USA. Electronic address: wsaronow@aol.com.

PMID: 28602366
DOI: 10.1016/j.hfc.2017.02.004

Abstract

Heart failure (HF) with abnormal left ventricular (LV) ejection fraction should be identified and treated. Treat hypertension with diuretics, angiotensin-converting enzyme (ACE) inhibitors, and β-blockers. Treat myocardial ischemia with nitrates and β-blockers. Treat volume overload and HF with diuretics. Treat HF with ACE inhibitors and β-blockers. Sacubitril/valsartan may be used instead of an ACE inhibitor or ARB in chronic symptomatic HF and abnormal LV ejection fraction. Add isosorbide dinitrate/hydralazine in African Americans with class II to IV HF treated with diuretics, ACE inhibitors, and β-blockers. Exercise training is recommended. Indications for implantable cardioverter-defibrillator and cardiac resynchronization therapy are discussed.

Keywords: Aldosterone antagonists; Angiotensin-converting enzyme inhibitors; Beta blockers; Digoxin; Heart failure; Myocardial infarction; Nitrates; Positive inotropic drugs.

Publication types

Review

MeSH terms

Age Factors
Aged
Aged, 80 and over
Female
Heart Failure / drug therapy*
Heart Failure / physiopathology*
Humans
Male
Middle Aged
Ventricular Dysfunction, Left