Diagnosis and Treatment of Systolic Heart Failure in the Elderly.
Appropriate therapy of systolic LV dysfunction in the elderly depends on the stage of the disease process. Evidence of systolic dysfunction is best detected by clinical assessment and echocardiographic exam. While one seeks to define and treat the factors that initiated the process, one also attempts to reduce symptoms and prolong life. Therefore, with initial damage (e.g., following a large myocardial infarction), ACE inhibition or angiotensin II receptor blockade is indicated. Ã -Adrenergic receptor blockade is also indicated at this stage because of mortality reduction. As failure progresses to more symptomatic phases, Ã -blockers also appear along with ACE inhibition. Once symptoms increase and peripheral edema and central congestion occur, loop diuretics become useful to maintain dry weight. In order to prevent further myocardial cell loss, other measures, such as cessation of smoking and treatment of hypertension, are essential. Digitalis glycosides, especially in modest doses, are indicated when NYHA Class II and III symptoms occur. Surgical approaches, such as coronary revascularization, may be performed to improve LV function in ischemic disease. Therapy of heart failure seeks the reversal or attenuation of the process that initiated the syndrome, while treating the patient to relieve symptoms and prolong life. Even in very late stages of the disease, relief of symptoms can now be accomplished with modest gains in life expectancy.
Frishman
William H.
WH
Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY.