Cardiology

Answer 3 Long-term use of beta-blockers risks worsening of CHF. Although the negative inotropic effect of beta-blockers was initially considered a risk in heart failure, these drugs actually improve ejection fraction in CHF. Although short-term deterioration may occur, continued therapy improves symptoms. Catecholamines cause vasoconstriction, increase metabolic demands, decrease diastolic filling, reduce coronary flow, and affect left ventricular remodeling; therefore, blocking chronic adrenergic stimulation is beneficial. The use of beta-blockers such as carvedilol and metoprolol results in improved ejection fraction (noticeable within a few months), fewer hospitalizations, and improved survival. SUGGESTED READINGS 1. Consensus recommendations for the management of chronic heart failure. On behalf of the membership of the advisory council to improve outcomes nationwide in heart failure. Am J Cardiol 1999;83:1A-38A. 2. Gomberg-Maitland M, Baran DA, Fuster V. Treatment of congestive heart failure: guidelines for the primary care physician and the heart failure specialist. Arch Intern Med 2001;161:342-52. 3. Heart failure. In: Arky RA, Kettyle WM, Hatem CJ, editors. MKSAP 12: Cardiovascular medicine. Philadelphia: American College of Physicians - American Society of Internal Medicine; 2001:38-49. Click here to return to the questions

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