A case of successful conservative therapy of patient with severe heart failure caused by ischemic heart disease: case report

Abstract

The development of heart failure in any patient causes a lot of concerns in view of the deterioration of quality of life of the latter. A clinical case of a patient with severe heart failure with a low left ventricular ejection fraction is described. The uniqueness of the demonstrated case consisted in the possibility of not only preserving the remaining resources of the heart muscle, but also in a significant restoration of systolic heart function due to adequate conservative therapy. The article presents a clinical case of successful restoration of contractile function of the heart in ischemic cardiomyopathy against the background of adequate conservative therapy. The diagnosis was not accompanied by difficulties. The patient underwent electrocardiography, echocardiography, coronary angiography, laboratory tests. According to the results patient was diagnosed with severe decompensated heart failure with reduced ejection fraction caused by coronary heart disease with NT-proBNP level of 286 ng/L. The results of coronary angiography did not reveal critical stenosis of the coronary arteries, and therefore the patient underwent drug treatment. Guideline-directed medical therapy treatment of chronic heart failure (angiotensin converting enzyme inhibitors, aldosterone antagonist, loop diuretics, beta-blockers, SGLT2 inhibitors) has allowed to achieve a good clinical result. Twelve months after beginning of the treatment left ventricular volume dimensions had changed significantly (LVEDV decreased from 220ml3 to 94ml3; LVESV from 162ml3 to 50 ml3), improvement of left ventricular ejection fraction from 17% to 42% (by Simson). The assessed 6-minute walk test showed functional class III according to the NYHA classification.