Department of Cardiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Indian J Med Res. 2010 Nov;132(5):549-60.
Heart failure is a common cardiovascular disease with high morbidity and mortality. Unlike western countries where heart failure is predominantly a disease of the elderly, in India it affects younger age group. Important risk factors include coronary artery disease, hypertension, diabetes mellitus, valvular heart disease and cardiomyopathies. Plasma brain natriuretic peptide levels are helpful in the diagnosis of heart failure. Echocardiography is the primary imaging modality of choice, through recently cardiac magnetic resonance imaging (MRI) has been found to play an increasing role. Aim of management is to improve symptoms & enhance survival. Diuretics are important in relieving symptoms. Beta-blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers and adosterone antagonists improve survival in patients with impaired systolic function. Device therapy including cardiac resynchronization therapy and implantable cardiac defibrillators, though expensive are useful in selected patients. Unlike in patients with systolic heart failure where several therapies have been shown to improve survival, clinical trial results in diastolic heart failure have been disappointing and therapy in these patients is restricted to symptom improvement and risk factor control. Therapies like stem cell therapy are being evaluated in clinical trials and appear promising. Early diagnosis and appropriate therapy helps in reversing the process of remodelling and clinical improvement in most of the patients.
心力衰竭是一种常见的心血管疾病，具有较高的发病率和死亡率。与西方国家心力衰竭主要发生在老年人不同，在印度，它影响的是更年轻的年龄组。重要的危险因素包括冠状动脉疾病、高血压、糖尿病、瓣膜性心脏病和心肌病。血浆脑钠肽水平有助于心力衰竭的诊断。超声心动图是首选的主要成像方式，最近发现心脏磁共振成像（MRI）的作用越来越大。管理的目的是改善症状和提高生存率。利尿剂在缓解症状方面很重要。对于收缩功能障碍的患者，β受体阻滞剂、血管紧张素转换酶（ACE）抑制剂、血管紧张素受体阻滞剂和醛固酮拮抗剂可提高生存率。心脏再同步治疗和植入式心脏除颤器等器械治疗虽然昂贵，但对某些患者有用。与已经证明几种疗法可改善收缩性心力衰竭患者生存率的情况不同，舒张性心力衰竭的临床试验结果令人失望，这些患者的治疗仅限于改善症状和控制危险因素。在临床试验中，正在评估像干细胞疗法这样的疗法，它们似乎很有前途。早期诊断和适当的治疗有助于逆转大多数患者的重塑过程和临床改善。
