Heart failure is difficult to define, since it is not a disease but a syndrome representing a final common pathway by which a number of disorders damage the heart to cause disability and premature death. A simplified definition is that heart failure is a condition in which there is inadequate tissue perfusion secondary to impaired ventricular function. The most common cause of heart failure is ischemic heart disease, though hypertension and various other myopathies may contribute. In Canada, 500 000 people suffer from congestive heart failure, with an equal number of males and females, a 150% increase since 1980.
The ultimate goal of management is to offset death and delay complications. The optimal type of management is lifestyle and dietary modification, which could be accompanied by pharmacological and surgical management.
Drug treatment may include positive inotropic agents, ACE inhibitors, beta blockers and spironolactone. In general, there should be judicious use of diuretics, followed by ACE inhibitors and aldosterone antagonists for all patients. Beta blockers can be used for generally stable class II-III patients, and vasodilators for patients who cannot tolerate ACE inhibitors. Inotropes may also be used.