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Left ventricular diastolic heart failure with normal left ventricular systolic function in older persons

W S Aronow1

  • 1Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY, USA.

The Journal of Laboratory and Clinical Medicine
|May 1, 2001
PubMed

Insights

Treatment for older adults with congestive heart failure (CHF) and normal left ventricular ejection fraction involves managing underlying causes and prioritizing sinus rhythm. Key therapies include diuretics, beta blockers, and ACE inhibitors as needed.

Area of Science:

  • Cardiology
  • Geriatrics

Background:

  • Congestive heart failure (CHF) in older adults with preserved ejection fraction presents unique management challenges.
  • Identifying and treating underlying and precipitating causes is crucial for effective CHF management.

Purpose of the Study:

  • To outline optimal therapeutic strategies for older individuals experiencing congestive heart failure with normal left ventricular ejection fraction.
  • To detail the stepwise pharmacological approach for managing this specific patient population.

Main Methods:

  • Review of current guidelines and evidence for CHF management in the elderly with preserved ejection fraction.
  • Description of a sequential drug therapy approach based on patient response and tolerance.

Main Results:

  • Recommended management includes maintaining sinus rhythm, controlling hypertension and ischemia, and managing fluid overload.
  • First-line treatment involves loop diuretics and beta blockers, followed by ACE inhibitors if needed.
  • Alternative medications like angiotensin II receptor blockers, hydralazine/isosorbide dinitrate, and calcium channel blockers are indicated for intolerance or persistent symptoms.

Conclusions:

  • A structured, stepwise pharmacological approach is effective for managing CHF in older adults with normal left ventricular ejection fraction.
  • Individualized treatment plans considering patient tolerance and response are essential for optimal outcomes.

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