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Heart failure resistant to standard medical therapy 

Heart failure resistant to standard medical therapy
Chapter:
Heart failure resistant to standard medical therapy
Author(s):

John Payne

and Ninian Lang

DOI:
10.1093/med/9780199692958.003.0021
Page of

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date: 23 September 2019

This chapter discusses the assessment and general management of patients with decompensated heart failure where standard medical therapy is failing and more advanced options are required. Assessment, with an emphasis on identification of at-risk individuals and early consultation with specialist units, is discussed in detail. The chapter then describes general principles of management including oxygenation, fluid removal, vasodilators, inotropes, and arrhythmias. It goes on to consider escalation to the various forms of mechanical support (intra-aortic balloon pump counter-pulsation (IABP), short- and long-term ventricular assist devices, extracorporeal membrane oxygenation) and cardiac transplantation. It ends with a discussion of end of life care and a consideration of the principles of weaning support in the recovering patient.

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