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(Circulation. 2003;108:1790.)
© 2003 American Heart Association, Inc.

Clinician Update

Aldosterone Blockade in Patients With Systolic Left Ventricular Dysfunction

Bertram Pitt, MD

From the University of Michigan School of Medicine, Ann Arbor, Mich.

Correspondence to Bertram Pitt, MD, University of Michigan School of Medicine, 3901 Taubman Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0366.

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The patient, W.L., is a 62-year-old white man with a history of hypertension, hypercholesterolemia, and an anterior Q-wave myocardial infarction 3 years ago. He has had 2 admissions for heart failure in the past 6 months. He was last discharged 2 months ago on aspirin 325 mg daily, simvastatin 40 mg daily, enalapril 10 mg BID, metoprolol XL 100 mg daily, digoxin 0.25 mg daily, and furosemide 120 mg BID. Over the past month, he has noted some increasing dyspnea on exertion and occasional episodes of paroxysmal nocturnal dyspnea but has not had any increase in peripheral edema or body weight. His left ventricular ejection fraction on discharge from the hospital 2 months ago was 26%, with evidence of a large anterior akinetic area but without evidence of inducible myocardial ischemia on dobutamine echocardiography. His laboratory data today included a hematocrit of 41%, serum creatinine 1.1 mg%, potassium 4.1 meq/L, fasting blood sugar 108 mg%, LDL cholesterol 92 mg/dL, HDL cholesterol 45 mg/dL, triglycerides 188 mg/dL, serum digoxin level 1.2, and brain natriuretic peptide (BNP) (Biosite) 508. ECG revealed evidence of an old anterior myocardial infarction, and chest x-ray showed cardiomegaly with some increase in pulmonary vascularity. At this time, would you suggest any change in his medical regimen?

Angiotensin-converting enzyme (ACE) inhibition and ß-blockade have been shown effective in improving survival in patients with systolic left ventricular dysfunction (SLVD) resulting from both ischemic and nonischemic cardiomyopathy; they are indicated in all patients with heart failure (HF) caused by SLVD . . . [Full Text of this Article]

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