[Pathophysiology and therapeutic implications of left heart failure].
OBJECTIVE
Heart failure is the ultimate step of most cardiovascular diseases. Its frequency increases regularly because of the progressive increase of life expectancy and better management of cardiovascular diseases. The prognosis is very poor (5-year mortality: 50%) as is quality of life; heart failure is a very costly disease. CURRENT KNOWLEDGE AND KEYS POINTS: Aims of treatment are improvement of symptoms and thus improvement of quality of life and increase of survival. The treatment systematically combines: general advice, dietary measures; medical treatment (with betablockers, ACE inhibitors and/or angiotensin II receptor antagonists, diuretics, in some cases aspirin or oral anticoagulants, digitalis and amiodarone) according to severity of heart failure, presence of congestion, aetiology, age; etiologic treatment if possible; treatment and prevention of precipitating and exacerbating factors. According to clinical and paraclinical features, one may propose cardiac multisite stimulation, cardiac surgery, physical stress training and cardiac transplantation. In order to decrease frequency of heart failure, prevention of cardiovascular diseases which lead to heart failure must be done as often is possible (hypertension, valvular heart disease, ischemic heart disease).


CONCLUSIONS
The future of the treatment of heart failure is the multidisciplinary management of heart failure (networks) led by hospital units specialized in heart failure.
de Gevigney
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G
Hôpital cardiovasculaire et pneumologique, 28, rue du Doyen-Lépine, 69677 Bron, France. guy.de-gevigney@chu-lyon.fr
Fol
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S
Delahaye
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F
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D006333:Heart Failure / Q000503:physiopathology* / Q000628:therapy*; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D008017:Life Expectancy; D011379:Prognosis; D011788:Quality of Life; D013534:Survival; D018487:Ventricular Dysfunction, Left
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics