Dilated cardiomyopathy and treatment of chronic heart failure

Prevention of heart failure is of the utmost importance in patients at risk. Heart failure should never be the only diagnosis. All patients with symptoms of heart failure should be investigated for the presence of left ventricular dysfunction. Patients should be advised to monitor weight gain. Patients with severe heart failure often develop malnutrition that is called cardiac cachexia, an important predictor of reduced survival. In acute heart failure physical rest or bed rest is recommended. Stable patients should be encouraged to and advised on how to carry out daily physical activities that do not induce symptoms. All patients with heart failure should be treated with both an ACE-inhibitor and a beta-blocker up-titrated to recommended doses if tolerated. An implantable cardioverter defibrillator (ICD) in combination with bi-ventricular pacing can be considered in patients who survived cardiac arrest or who have sustained ventricular tachycardia which is associated with severe heart failure (NYHA FC III - IV) with a left ventricular ejection fraction lUgll/Ug 35% and QRS duration of lUggl/Ug 120 ms to improve mortality and morbidity.