INDIVIDUALIZED TREATMENT STRATEGY FOR ACUTE EXACERBATION OF CHRONIC HEART FAILURE IN PATIENT WITH DILATED CARDIOMYOPATHY: WHAT IS THE OPTIMAL TREATMENT?

Abstract

Objective: To study clinical cases of acute heart failure based on dilated cardiomyopathy to clearly see what is the most optimal treatment in each clinical case.

Research method: Clinical case report and review of the literature. Research on a clinical case of acute heart failure in a patient with chronic heart failure with dilated cardiomyopathy at the Vietnam National Heart Institute, Bach Mai Hospital. Optimal medical treatment of heart failure while treating the underlying disease well helps improve heart function and clinical improvement.

Case report: The 59-year-old male patient was admitted to the Vietnam National Heart Institute - Bach Mai Hospital because of New York Heart Association (NYHA) III-IV dyspnea and bilateral lower extremity edema, with less urine about 700 - 800 ml/24 hours, Ejection Fraction (EF) 18%. History of type 2 diabetes, hypertension, old pulmonary tuberculosis, newly discovered dilated cardiomyopathy 6 months ago, and hospitalized without any treatment. Do not smoke and use alcohol. Patients were treated aggressively during the acute decompensated heart failure episode as well as optimized with foundational medications such as Angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, aldosterone antagonists, and digitalis (Digoxin) to help Stabilize treatment of NYHA II, and EF 45% before discharge, and myocardial resynchronization therapy with CRT implantation was prescribed.

Conclusion: The treatment strategy for this patient is to first treat acute decompensated heart failure, then stabilize medical treatment with foundational drugs at the target or optimal dose for the patient. The addition of 2 therapies, Ivabradine and cardiac resynchronization, is a very reasonable indication that will improve functional status and quality of life while reducing the patient's risk of hospitalization and death; However, while waiting for the decision to intervene in CRT implantation from the patient's family, optimal medical treatment is needed. Current clinical evidence has shown that optimal medical treatment is individualized. Chemotherapy helped improve and stabilize this patient's clinical condition, helping to improve the prognosis.