Advanced Strategies in the Diagnosis and Treatment of Patients with Coronary Artery Disease and Heart Failure: When Heart Failure Causes Ischemia and Angiotensin Converting Enzyme Inhibitor and Betablockers Helps in Diuresis

Abstract

In the diagnosis and management of patients with Coronary Artery Disease (CAD) and chronic Left Ventricular (LV) dysfunction or Heart Failure (HF), there are many uncertainties because of the non-specificity of the symptoms and signs of HF. Usually, severe CAD causes LV dysfunction. However, not rarely, LV dysfunction is the cause or aggravation of ischemia to many subsets of patients with or without CAD. In this article, the care of patients with CAD with LV dysfunction, along with the challenges of diagnosing asymptomatic HF and the criteria for monitoring success are presented. Then the evidence of LV dysfunction triggering or aggravating ischemia is discussed. The newest methodology of assessing the venous blood volume which causes the main presentations of HF when its filling capacity is exceeded will also be presented in details. In summary, the effects of fluid mobilization by conventional medications for CAD (e.g Angiotensin Converting Enzyme Inhibitors (ACEI) or Beta-blockers (BB) and their therapeutic mechanisms are discussed. The goal of this review is to present the cardiologist consultants strong scientific evidence of detrimental interaction between CAD and LV dysfunction and the therapeutic action of ACEI and BB in the mobilization of venous fluid. As a result, the management of patients with CAD and HF could be exercised on an advanced level of expertise.

Keywords: Coronary Artery Disease (CAD); Fluid overload; Heart failure; Intravascular fluid volume; Size and expansion of common femoral vein; Venous fluid volume..