Heart failure – how can we further enhance pharmacotheraphy? Case report

Abstract

Patients with chronic heart failure, particularly with impaired left ventricular systolic function benefit from the reduction of the resting heart rate below 70/min., which has been proven in numerous clinical studies. SHIFT study has shown that adding ivabradine to the therapy of patients with difficulties in obtaining resting heart rate control despite of usage of betablockers in the maximum dose, or if the increase of β-blocker dose is contraindicated. The paper presents two clinical cases of patients receiving ivabradine that effectively reduced resting heart rate. In the first case, 73-year-old woman with chronic ischemic heart failure with impaired systolic function of the left ventricle (EF 30%) receiving β-blockers at the maximum dose did not achieve the desired release of the heart rate and adding ivabradine to the therapy allowed to gain the expected clinical effect. In the second case of 64-year-old woman also with ischemic chronic heart failure, obesity and COPD, not tolerating high doses of β-blocker use of ivabradine was associated with effective decrease of the heart rate.