What is the diagnosis and treatment for heart (cardiac) disease?

From the Guidelines

The management of heart failure should focus on reducing modifiable risk factors, and the use of ACE inhibitors and beta blockers is recommended in all patients with stage B or C heart failure who have a reduced ejection fraction, as stated in the guidelines by the American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) 1. The heart is a complex organ that can be affected by various conditions, including heart failure, which is a clinical syndrome that results from structural or functional impairment of ventricular filling or ejection of blood. Key points to consider in the management of heart failure include:

• Treatment of stage A heart failure should focus on reducing modifiable risk factors, including management of hypertension and hyperlipidemia 1.
• Patients with stage C heart failure and fluid retention should be treated with diuretics in addition to ACE inhibitors and beta blockers 1.
• The use of ACE inhibitors and beta blockers has been shown to reduce morbidity and mortality in patients with heart failure, and should be used in all patients with stage B or C heart failure who have a reduced ejection fraction 1. It's also important to note that the management of heart failure involves a comprehensive approach that includes lifestyle modifications, such as dietary changes and exercise, as well as the use of medications to manage symptoms and slow disease progression. In terms of specific treatments, the guidelines recommend the use of ACE inhibitors and beta blockers as first-line therapies for patients with heart failure, and also recommend the use of diuretics to manage fluid retention in patients with stage C heart failure 1. Additionally, the guidelines emphasize the importance of assessing and managing underlying conditions that may be contributing to heart failure, such as coronary artery disease or valvular heart disease 1. Overall, the management of heart failure requires a comprehensive and individualized approach that takes into account the patient's specific needs and circumstances, and the use of evidence-based therapies to reduce morbidity and mortality.

From the FDA Drug Label

1. 2 Heart Failure In two placebo controlled, 12-week clinical studies compared the addition of lisinopril up to 20 mg daily to digitalis and diuretics alone. The combination of lisinopril, digitalis and diuretics reduced the following signs and symptoms of heart failure: edema, rales, paroxysmal nocturnal dyspnea and jugular venous distention A large (over 3,000 patients) survival study, the ATLAS Trial, comparing 2. 5 mg and 35 mg of lisinopril in patients with systolic heart failure, showed that the higher dose of lisinopril had outcomes at least as favorable as the lower dose During baseline-controlled clinical trials, in patients with systolic heart failure receiving digitalis and diuretics, single doses of lisinopril resulted in decreases in pulmonary capillary wedge pressure, systemic vascular resistance and blood pressure accompanied by an increase in cardiac output and no change in heart rate.

Lisinopril is used to treat heart failure by reducing signs and symptoms such as:

• Edema
• Rales
• Paroxysmal nocturnal dyspnea
• Jugular venous distention It also decreases pulmonary capillary wedge pressure, systemic vascular resistance, and blood pressure, while increasing cardiac output, in patients with systolic heart failure 2.

From the Research

Heart Health and Cardiovascular Diseases

• Cardiovascular disease is the leading cause of mortality worldwide, affecting a wide range of patients at different stages across the cardiovascular continuum 3.
• Hypertension is one of the earliest risk factors in this continuum and can be controlled in most patients with currently available antihypertensive agents 3.
• The combination of beta-blockers and ACE inhibitors is of special interest due to their complementary actions on the sympathetic nervous system and renin-angiotensin-aldosterone system, two interlinked pathways that influence cardiovascular risk and disease outcomes 3.

Treatment and Management of Hypertension

• The combination of lisinopril and amlodipine has been shown to be effective in treating essential hypertension, with a significant additional blood pressure-lowering effect compared to either drug alone 4.
• The response to lisinopril is related to baseline plasma renin activity, whereas the response to amlodipine is independent of baseline renin activity 4.
• Combining established antihypertensive agents into a single pill can provide effective blood pressure lowering and improved cardiovascular outcomes, allowing a greater proportion of patients to rapidly achieve treatment targets 5, 3.

Symptomatic Patients with Benign or Non-Existent Medical Disease

• Reassurance is an important therapy for patients with benign disease or symptoms not explained by disease, and can be effective if systematic steps are followed, including questioning and examining the patient, assuring the patient that serious illness is not present, and suggesting the symptom will resolve 6.
• Medically unexplained symptoms (MUS) present a major challenge for primary care providers, and managing MUS requires co-creating plausible explanations, understanding the pitfalls of consultations involving MUS, and developing multimodal treatment plans 7.