Heart Failure

Updated: Jan 28, 2022 

Author: Ioana Dumitru, MD; Chief Editor: Gyanendra K Sharma, MD,
FACC, FASE  more...
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Practice Essentials
Heart failure develops when the heart, via an abnormality of cardiac
function (detectable or not), fails to pump blood at a rate commensurate
with the requirements of the metabolizing tissues or is able to do so only
with an elevated diastolic filling pressure. See the image below.
 Heart Failure. This chest
radiograph shows an enlarged cardiac silhouette and edema at the lung
bases, signs of acute heart failure.

Heart Failure Treatment & Management

Updated: Jan 28, 2022 
 Author: Ioana Dumitru, MD; Chief Editor: Gyanendra K Sharma, MD,
FACC, FASE  more...
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Approach Considerations
Medical care for heart failure includes a number of nonpharmacologic,
pharmacologic, and invasive strategies to limit and reverse its
manifestations. [3, 4, 112] Depending on the severity of the illness,
nonpharmacologic therapies include dietary sodium and fluid restriction;
physical activity as appropriate; and attention to weight gain.
Pharmacologic therapies include the use of diuretics, vasodilators, inotropic
agents, anticoagulants, beta-blockers, and digoxin.
Clinical practice guidelines on the management of heart failure by the
European Society of Cardiology (ESC) were published in August 2021.
Recommendations include the following [64] :
 Treatment of acute HF is based on the use of diuretics for
congestion, inotropes, and short-term MCS (mechanical
circulatory support) for peripheral hypoperfusion.
 ACE-I (angiotensin-converting enzyme inhibitor) or ARNI
(angiotensin receptor-neprilysin inhibitor), beta blockers, MRA
(mineralocorticoid receptor antagonist), and SGLT2 (sodium-
glucose cotransporter 2) inhibitors are recommended for patients
with HFrEF (HF with reduced ejection fraction).
 Right heart catheterization should be considered in all patients in
whom HF is thought to be due to constrictive pericarditis,
 restrictive cardiomyopathy, congenital heart disease, and high
output stress.
 Dapagliflozin or empagliflozin is recommended for patients with
HFrEF to reduce the risk of hospitalization and death due to HF.
 Heart transplantation is recommended for patients who have
advanced HF that is refractory to medical/device therapy and
who do not have absolute contraindications.SGLT2 inhibitors
(canagliflozin, dapagliflozin, empagliflozin, etrugliflozin,
sotagliflozin) are recommended in patients with type 2 diabetes
mellitus who are at risk for cardiovascular events, to reduce
hospitalizations for HF, major cardiac events, end-stage renal
dysfunction, and cardiovascular death.