FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 335:490-498 August 15, 1996 Number 7 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

	Full Text PDF Purchase this article Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article by Howard, P. A. PubMed Citation

Heart failure is a complex of symptoms — fatigue, shortness of breath, and congestion — that are related to the inadequate perfusion of tissue during exertion and often to the retention of fluid. Its primary cause is an impairment of the heart's ability to fill or empty the left ventricle properly.

The management of heart failure can no longer be confined to the relief of symptoms. The processes that contribute to left ventricular dysfunction may progress independently from the development of symptoms (Figure 1). Treatment to prevent or delay the progression of left ventricular dysfunction may therefore be . . . [Full Text of this Article]

The Mechanisms and Diagnosis of Left Ventricular Dysfunction

The Mechanisms and Diagnosis of Heart Failure

Goals of Therapy

Relief of Symptoms

Nonpharmacologic Management

Drug Therapy

            Diuretics

            Vasodilators

            Digoxin

Prolonging the Lives of Patients with Left Ventricular Dysfunction

Nonpharmacologic Management

Drug Therapy

            ACE Inhibitors

            Hydralazine and Isosorbide Dinitrate

            Antiarrhythmic Drugs

            Anticoagulant Therapy

Common Errors in the Management of Heart Failure

Not Recognizing Heart Failure

Improper Dosage of Diuretics

Failure to Assess the Quality of Life

Failure to Consider Long-Term Therapeutic Goals

Inadequate Dosage of ACE Inhibitors

Failure to Use Hydralazine and Isosorbide Dinitrate

Use of Potentially Harmful Drugs

New Approaches to Management

Beta-Adrenergic Antagonists

Beta-Adrenergic Antagonists with Vasodilative Action

Vesnarinone

Calcium Antagonists

Neurohormonal Inhibitors

Other Drugs with Cardiac Action

Optimal Management

Source Information

From the Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Box 508 UMHC, 420 Delaware St. S.E., Minneapolis, MN 55455, where reprint requests should be addressed to Dr. Cohn.

References

Related Letters:

The Management of Chronic Heart Failure
Howard P. A., Dunn M. I., Sahebjami H., Cohn J. N.
Extract | Full Text  
N Engl J Med 1997; 336:295-296, Jan 23, 1997. Correspondence

This article has been cited by other articles:

• Landolina, M., Gasparini, M., Lunati, M., Santini, M., Rordorf, R., Vincenti, A., Diotallevi, P., Montenero, A. S., Bonanno, C., De Santo, T., Valsecchi, S., Padeletti, L., InSync/InSync ICD Italian Registry Investigators, (2008). Heart rate variability monitored by the implanted device predicts response to CRT and long-term clinical outcome in patients with advanced heart failure. Eur J Heart Fail 10: 1073-1079 [Abstract] [Full Text]  
• Frey, U. H., Lieb, W., Erdmann, J., Savidou, D., Heusch, G., Leineweber, K., Jakob, H., Hense, H.-W., Lowel, H., Brockmeyer, N. H., Schunkert, H., Siffert, W. (2008). Characterization of the GNAQ promoter and association of increased Gq expression with cardiac hypertrophy in humans. Eur Heart J 29: 888-897 [Abstract] [Full Text]  
• Khush, K. K., Waters, D. D., Bittner, V., Deedwania, P. C., Kastelein, J. J.P., Lewis, S. J., Wenger, N. K. (2007). Effect of High-Dose Atorvastatin on Hospitalizations for Heart Failure: Subgroup Analysis of the Treating to New Targets (TNT) Study. Circulation 115: 576-583 [Abstract] [Full Text]  
• Gheorghiade, M., Sopko, G., De Luca, L., Velazquez, E. J., Parker, J. D., Binkley, P. F., Sadowski, Z., Golba, K. S., Prior, D. L., Rouleau, J. L., Bonow, R. O. (2006). Navigating the Crossroads of Coronary Artery Disease and Heart Failure. Circulation 114: 1202-1213 [Full Text]  
• Talens-Visconti, R., Rivera Otero, M., Sancho-Tello, M. J., de Burgos, F. G., Martinez-Dolz, L., Sevilla, B., Climent, V., Cortes, R., Salvador, A., Sogorb, F., Miro, V., Valero, R., Perez-Bosca, J. L., Bertomeu, V., Portoles, M., Paya, R. (2006). Left ventricular cavity area reflects N-terminal pro-brain natriuretic peptide plasma levels in heart failure. Eur J Echocardiogr 7: 45-52 [Abstract] [Full Text]  
• Carson, P., Anand, I., O'Connor, C., Jaski, B., Steinberg, J., Lwin, A., Lindenfeld, J., Ghali, J., Barnet, J. H., Feldman, A. M., Bristow, M. R. (2005). Mode of Death in Advanced Heart Failure: The Comparison of Medical, Pacing, and Defibrillation Therapies in Heart Failure (COMPANION) Trial. J Am Coll Cardiol 46: 2329-2334 [Abstract] [Full Text]  
• Opasich, C., Cazzola, M., Scelsi, L., De Feo, S., Bosimini, E., Lagioia, R., Febo, O., Ferrari, R., Fucili, A., Moratti, R., Tramarin, R., Tavazzi, L. (2005). Blunted erythropoietin production and defective iron supply for erythropoiesis as major causes of anaemia in patients with chronic heart failure. Eur Heart J 26: 2232-2237 [Abstract] [Full Text]  
• Nagaya, N., Kangawa, K., Itoh, T., Iwase, T., Murakami, S., Miyahara, Y., Fujii, T., Uematsu, M., Ohgushi, H., Yamagishi, M., Tokudome, T., Mori, H., Miyatake, K., Kitamura, S. (2005). Transplantation of Mesenchymal Stem Cells Improves Cardiac Function in a Rat Model of Dilated Cardiomyopathy. Circulation 112: 1128-1135 [Abstract] [Full Text]  
• Rivera, M., Talens-Visconti, R., Sirera, R., Bertomeu, V., Salvador, A., Cortes, R., de Burgos, F. G., Climent, V., Paya, R., Martinez-Dolz, L., Sancho-Tello, M. J., Gonzalez-Molina, A. (2004). Soluble TNF-{alpha} and interleukin-6 receptors in the urine of heart failure patients. Their clinical value and relationship with plasma levels. Eur J Heart Fail 6: 877-882 [Abstract] [Full Text]  
• Adamson, P. B., Smith, A. L., Abraham, W. T., Kleckner, K. J., Stadler, R. W., Shih, A., Rhodes, M. M., on behalf of the InSync III Model 8042 and Attain, (2004). Continuous Autonomic Assessment in Patients With Symptomatic Heart Failure: Prognostic Value of Heart Rate Variability Measured by an Implanted Cardiac Resynchronization Device. Circulation 110: 2389-2394 [Abstract] [Full Text]  
• Karim, S. M., Rhee, A. Y., Given, A. M., Faulx, M. D., Hoit, B. D., Brozovich, F. V. (2004). Vascular Reactivity in Heart Failure: Role of Myosin Light Chain Phosphatase. Circ. Res. 95: 612-618 [Abstract] [Full Text]  
• Norris, W., Kunzelman, K. S., Bussell, S., Rohweder, L., Cochran, R. P. (2004). Potassium Supplementation, Diet vs Pills: A Randomized Trial in Postoperative Cardiac Surgery Patients. Chest 125: 404-409 [Abstract] [Full Text]  
• Jessup, M., Brozena, S. (2003). Heart Failure. NEJM 348: 2007-2018 [Full Text]  
• Sirera, R., Salvador, A., Roldan, I., Talens, R., Gonzalez-Molina, A., Rivera, M. (2003). Quantification of proinflammatory cytokines in the urine of congestive heart failure patients. Its relationship with plasma levels. Eur J Heart Fail 5: 27-31 [Abstract] [Full Text]  
• Tenenbaum, A., Fisman, E. Z., Motro, M. (2002). Toward a redefinition of ischemic cardiomyopathy: is it an indivisible entity?. J Am Coll Cardiol 40: 205-206 [Full Text]  
• Alonso-Martinez, J.L., Llorente-Diez, B., Echegaray-Agara, M., Olaz-Preciado, F., Urbieta-Echezarreta, M., Gonzalez-Arencibia, C. (2002). C-reactive protein as a predictor of improvement and readmission in heart failure. Eur J Heart Fail 4: 331-336 [Abstract] [Full Text]  
• Guazzi, M, Pontone, G, Brambilla, R, Agostoni, P, Reina, G (2002). Alveolar-capillary membrane gas conductance: a novel prognostic indicator in chronic heart failure. Eur Heart J 23: 467-476 [Abstract] [Full Text]  
• Nicolas, J. M., Fernandez-Sola, J., Estruch, R., Pare, J. C., Sacanella, E., Urbano-Marquez, A., Rubin, E. (2002). The Effect of Controlled Drinking in Alcoholic Cardiomyopathy. ANN INTERN MED 136: 192-200 [Abstract] [Full Text]  
• Muller, F. U, Boknik, P., Knapp, J., Linck, B., Luss, H., Neumann, J., Schmitz, W. (2001). Activation and inactivation of cAMP-response element-mediated gene transcription in cardiac myocytes. Cardiovasc Res 52: 95-102 [Abstract] [Full Text]  
• Grassi, G., Turri, C., Seravalle, G., Bertinieri, G., Pierini, A., Mancia, G. (2001). Effects of Chronic Clonidine Administration on Sympathetic Nerve Traffic and Baroreflex Function in Heart Failure. Hypertension 38: 286-291 [Abstract] [Full Text]  
• Gomberg-Maitland, M., Baran, D. A., Fuster, V. (2001). Treatment of Congestive Heart Failure: Guidelines for the Primary Care Physician and the Heart Failure Specialist. Arch Intern Med 161: 342-352 [Abstract] [Full Text]  
• Kusumoto, K., Haist, J. V., Karmazyn, M. (2001). Na+/H+ exchange inhibition reduces hypertrophy and heart failure after myocardial infarction in rats. Am. J. Physiol. Heart Circ. Physiol. 280: H738-H745 [Abstract] [Full Text]  
• Sato, Y., Yamada, T., Taniguchi, R., Nagai, K., Makiyama, T., Okada, H., Kataoka, K., Ito, H., Matsumori, A., Sasayama, S., Takatsu, Y. (2001). Persistently Increased Serum Concentrations of Cardiac Troponin T in Patients With Idiopathic Dilated Cardiomyopathy Are Predictive of Adverse Outcomes. Circulation 103: 369-374 [Abstract] [Full Text]  
• Nieminen, M. S., Akkila, J., Hasenfuss, G., Kleber, F. X., Lehtonen, L. A., Mitrovic, V., Nyquist, O., Remme, W. J., on behalf of the Study Group, (2000). Hemodynamic and neurohumoral effects of continuous infusion of levosimendan in patients with congestive heart failure. J Am Coll Cardiol 36: 1903-1912 [Abstract] [Full Text]  
• Bauersachs, J., Fraccarollo, D., Ertl, G., Gretz, N., Wehling, M., Christ, M. (2000). Striking Increase of Natriuresis by Low-Dose Spironolactone in Congestive Heart Failure Only in Combination With ACE Inhibition : Mechanistic Evidence to Support RALES. Circulation 102: 2325-2328 [Abstract] [Full Text]  
• Pepper, J. R (2000). Surgery for heart failure: options and outcomes. Perfusion 15: 287-293  
• Kleber, F. X., Vietzke, G., Wernecke, K. D., Bauer, U., Opitz, C., Wensel, R., Sperfeld, A., Glaser, S. (2000). Impairment of Ventilatory Efficiency in Heart Failure : Prognostic Impact. Circulation 101: 2803-2809 [Abstract] [Full Text]  
• Rossi, A., Enriquez-Sarano, M., Burnett, J. C. Jr., Lerman, A., Abel, M. D., Seward, J. B. (2000). Natriuretic peptide levels in atrial fibrillation: A prospective hormonal and Doppler-echocardiographic study. J Am Coll Cardiol 35: 1256-1262 [Abstract] [Full Text]  
• Levine, T. B., Bernink, P. J. L. M., Caspi, A., Elkayam, U., Geltman, E. M., Greenberg, B., McKenna, W. J., Ghali, J. K., Giles, T. D., Marmor, A., Reisin, L. H., Ammon, S., Lindberg, E. (2000). Effect of Mibefradil, a T-Type Calcium Channel Blocker, on Morbidity and Mortality in Moderate to Severe Congestive Heart Failure : The MACH-1 Study. Circulation 101: 758-764 [Abstract] [Full Text]  
• Walker, C. A., Crawford, F. A. Jr, Spinale, F. G. (2000). MYOCYTE CONTRACTILE DYSFUNCTION WITH HYPERTROPHY AND FAILURE: RELEVANCE TO CARDIAC SURGERY. J. Thorac. Cardiovasc. Surg. 119: 388-400 [Full Text]  
• Gambassi, G., Lapane, K. L., Sgadari, A., Carbonin, P., Gatsonis, C., Lipsitz, L. A., Mor, V., Bernabei, R., for the SAGE Study Group, (2000). Effects of Angiotensin-Converting Enzyme Inhibitors and Digoxin on Health Outcomes of Very Old Patients With Heart Failure. Arch Intern Med 160: 53-60 [Abstract] [Full Text]  
• Young, J. B. (1999). Angiotensin-converting enzyme inhibitors and cytokines in heart failure: dose and effect?. J Am Coll Cardiol 34: 2068-2071 [Full Text]  
• Collins, K. A., Bennett, A. T., Hanzlick, R., and the Autopsy Committee of the College of Americ, (1999). Case of the Month: The Autopsy and the Living. Arch Intern Med 159: 2391-2392 [Full Text]  
• Pitt, B., Zannad, F., Remme, W. J., Cody, R., Castaigne, A., Perez, A., Palensky, J., Wittes, J., The Randomized Aldactone Evaluation Study Investig, (1999). The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure. NEJM 341: 709-717 [Abstract] [Full Text]  
• Diller, P. M., Smucker, D. R., David, B., Graham, R. J. (1999). Congestive Heart Failure Due to Diastolic or Systolic Dysfunction: Frequency and Patient Characteristics in an Ambulatory Setting. Arch Fam Med 8: 414-420 [Abstract] [Full Text]  
• Bart, B.A., Ertl, G., Held, P., Kuch, J., Maggioni, A.P., McMurray, J., Michelson, E.L., Rouleau, J.L., Warner Stevenson, L., Swedberg, K., Young, J.B., Yusuf, S., Sellers, M.A., Granger, C.B., Califf, R.M., Pfeffer, M.A., for the SPICE investigators, (1999). Contemporary management of patients with left ventricular systolic dysfunction. Results from the Study of Patients Intolerant of Converting Enzyme Inhibitors (SPICE) Registry. Eur Heart J 20: 1182-1190 [Abstract]  
• Coodley, E. (1999). Newer Drug Therapy for Congestive Heart Failure. Arch Intern Med 159: 1177-1183 [Abstract] [Full Text]  
• Cohn, J. N., Goldstein, S. O., Greenberg, B. H., Lorell, B. H., Bourge, R. C., Jaski, B. E., Gottlieb, S. O., McGrew, F., DeMets, D. L., White, B. G., The Vesnarinone Trial Investigators, (1998). A Dose-Dependent Increase in Mortality with Vesnarinone among Patients with Severe Heart Failure. NEJM 339: 1810-1816 [Abstract] [Full Text]  
• van Veldhuisen, D. J., Genth-Zotz, S., Brouwer, J., Boomsma, F., Netzer, T., Man in 't Veld, A. J., Pinto, Y. M., Lie, K. I., Crijns, H. J. G. M. (1998). High- versus low-dose ACE inhibition in chronic heart failure: A double-blind, placebo-controlled study of imidapril. J Am Coll Cardiol 32: 1811-1818 [Abstract] [Full Text]  
• Nolan, J., Batin, P. D., Andrews, R., Lindsay, S. J., Brooksby, P., Mullen, M., Baig, W., Flapan, A. D., Cowley, A., Prescott, R. J., Neilson, J. M.M., Fox, K. A.A. (1998). Prospective Study of Heart Rate Variability and Mortality in Chronic Heart Failure : Results of the United Kingdom Heart Failure Evaluation and Assessment of Risk Trial (UK-Heart). Circulation 98: 1510-1516 [Abstract] [Full Text]  
• Young, J. B., Gheorghiade, M., Uretsky, B. F., Patterson, J. H., Adams, K. F. Jr. (1998). Superiority of "triple" drug therapy in heart failure: insights from the PROVED and RADIANCE trials. J Am Coll Cardiol 32: 686-692 [Abstract] [Full Text]  
• Campbell, N., Brant, R., Stalts, H., Stone, J., Mahallati, H. (1998). Fluctuations in Blood Lipid Levels During Furosemide Therapy: A Randomized, Double-blind, Placebo-Controlled Crossover Study. Arch Intern Med 158: 1461-1463 [Abstract] [Full Text]  
• Javaheri, S., Parker, T. J., Liming, J. D., Corbett, W. S., Nishiyama, H., Wexler, L., Roselle, G. A. (1998). Sleep Apnea in 81 Ambulatory Male Patients With Stable Heart Failure : Types and Their Prevalences, Consequences, and Presentations. Circulation 97: 2154-2159 [Abstract] [Full Text]  
• Hunt, S. A., Frazier, O.H. (1998). Mechanical Circulatory Support and Cardiac Transplantation. Circulation 97: 2079-2090 [Full Text]  
• Redaelli, G., Malhotra, A., Li, B., Li, P., Sonnenblick, E. H., Hofmann, P. A., Anversa, P. (1998). Effects of Constitutive Overexpression of Insulin-Like Growth Factor-1 on the Mechanical Characteristics and Molecular Properties of Ventricular Myocytes. Circ. Res. 82: 594-603 [Abstract] [Full Text]  
• Estacio, R. O., Jeffers, B. W., Hiatt, W. R., Biggerstaff, S. L., Gifford, N., Schrier, R. W. (1998). The Effect of Nisoldipine as Compared with Enalapril on Cardiovascular Outcomes in Patients with Non-Insulin-Dependent Diabetes and Hypertension. NEJM 338: 645-652 [Abstract] [Full Text]  
• Gheorghiade, M., Bonow, R. O. (1998). Chronic Heart Failure in the United States : A Manifestation of Coronary Artery Disease. Circulation 97: 282-289 [Full Text]  
• Deedwania, P. C. (1997). Underutilization of Evidence-Based Therapy in Heart Failure: An Opportunity to Deal a Winning Hand With Ace up Your Sleeve. Arch Intern Med 157: 2409-2412 [Abstract]  
• Stafford, R. S., Saglam, D., Blumenthal, D. (1997). National Patterns of Angiotensin-Converting Enzyme Inhibitor Use in Congestive Heart Failure. Arch Intern Med 157: 2460-2464 [Abstract]  
• Howard, P. A., Dunn, M. I., Sahebjami, H., Cohn, J. N. (1997). The Management of Chronic Heart Failure. NEJM 336: 295-296 [Full Text]