Prevention and Treatment of Precipitating Factors

The compensated condition in stage B Heart Failure or C Heart Failure can change quickly when any precipitating factor tips over the precarious clinical balance. This is why prevention of any precipitating or aggravating factor is the second most important strategy in this group of asymptomatic patients. The goal is to keep the patient asymptomatic as long as possible and it is an achievable goal.

Precipitating factors of Heart Failure

1. Infection
2. Brady-or tachyarrhythmia
3. Myocardial ischemia or MI
4. Physical or Emotional stress
5. Pulmonary embolism
6. High-output states such as anemia, thyrotoxicosis, Paget’s disease, pregnancy, Beriberi and arteriovenous fistula
7. Cardia infection and inflammation (myocarditis, infective endocarditis)
8. Comorbidities (renal, liver, thyroid,respiratory insufficiency)
9. Cardiac toxin (chemotherapy,cocaine,alcohol etc)

Conditions in which ventricular remodeling could be reversed

1. Viral cardiomyo[pathy
2. Post partum cardiomyopathy
3. Atrial fibrillation induced cardiomyopathy
4. Aortic stenosis with LV hypertrophy
5. Mitral regurgitation with dilated ft ventricle
6. ETOH induced dilated cardiomyopathy
7. Dilated left ventricle from metabolic syndrome
8. LV hypertrophy after long standing uncontrolled HTN
9. Stress induced cardiomyopathy
10. Tachycardia mediated cardiomyopathy
11. Nutritional deficiency, beriberi, selenium deficiency
12. Metabolic causes: hypocalcemia, hypophosphate
13. Endocrine disorders: hypo and hyperthyroidism

It is important to correct the underlying disease which causes ventricular remodeling such as CAD, arrhythmias, ETOH, because the LV remodeling could be reversed and the disease progression stopped. The evidence that treatment with BB reversed the LV remodeling is well illustrated.
Eventually the LV modeling dilation or hypertrophy is regarded detrimental; this is why reversal of LV dilation is an ideal goal and concrete evidence of treatment success. The LV dilation can be transient or disappears after a few months.

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