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Chronic heart failure: Definitions, investigation, and management 

Chronic heart failure: Definitions, investigation, and management
Chronic heart failure: Definitions, investigation, and management

John G.F. Cleland

, and Andrew L. Clark

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date: 05 March 2021

Heart failure is a common clinical syndrome, predominantly a disease of older people, often presenting with breathlessness, fatigue, and peripheral oedema. Its pathophysiology is complex, with a common feature being salt and water retention, possibly triggered by a relative fall in renal perfusion pressure. Common aetiologies include ischaemic heart disease, hypertension, and valvular heart disease. New treatments have improved prognosis substantially over the past two decades. Early diagnosis relies on a low threshold of suspicion and screening of people at risk. Treatable causes for heart failure should be identified and corrected. Pharmacological therapy is given to improve symptoms and prognosis. Diuretic therapy is the mainstay for control of congestion and symptoms, but its effect on long-term prognosis is unknown. For patients with HFrEF, either angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor–neprilysin inhibitors, combined with β‎-blockers and mineralocorticoid receptor antagonists (triple therapy) provide both symptomatic and prognostic benefit.

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