Refractory heart failure: Optimizing therapy, managing end-stage disease. A guide to making the best use of standard and new treatments

R. Sangrigoli, Ileana L. Pina

Research output: Contribution to journalArticle

Abstract

Heart failure is deemed refractory when it is severe enough to resist maximal standard medical therapy. Before reaching that conclusion, however, confirm the accuracy of diagnosis, absence of other illness, full compliance with therapy, absence of complicating drug therapy, and other obvious points. Ensure, too, that the patient has indeed received optimal therapy, which may include the following, as indicated: restriction of dietary salt and water, aggressive diuresis, digoxin when left ventricular ejection fraction is less than 35%, an angiotensin-converting enzyme inhibitor given at a dosage proved to be effective and safe, a β-blocker, an angiotensin II receptor antagonist, and anticoagulation. For ischemic cardiomyopathy with large areas of injured but viable tissue, coronary artery bypass graft surgery can improve survival, ventricular function, and symptoms. Left ventricular assist devices can serve as bridges to heart transplantation.

Original languageEnglish (US)
Pages (from-to)571-580
Number of pages10
JournalJournal of Critical Illness
Volume14
Issue number10
StatePublished - 1999
Externally publishedYes

Fingerprint

Heart Failure
Heart-Assist Devices
Ventricular Function
Angiotensin Receptor Antagonists
Diuresis
Digoxin
Heart Transplantation
Cardiomyopathies
Angiotensin-Converting Enzyme Inhibitors
Coronary Artery Bypass
Stroke Volume
Therapeutics
Salts
Transplants
Drug Therapy
Survival
Water
Ensure

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Refractory heart failure : Optimizing therapy, managing end-stage disease. A guide to making the best use of standard and new treatments. / Sangrigoli, R.; Pina, Ileana L.

In: Journal of Critical Illness, Vol. 14, No. 10, 1999, p. 571-580.

Research output: Contribution to journalArticle

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