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Management and Prognosis of Heart Failure

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  1. Introduction
  2. Approaching a patient with heart failure
  3. Prevention of heart failure
  4. Outpatient treatment of heart failure
  5. The concomitant use of quinidine, verapamil, spironolactone, flecainide, propafenone, and amiodarone
  6. Conclusions
  7. Bibliography

The cardinal manifestations of heart failure are (1) dyspnea and fatigue, which may limit exercise tolerance, and (2) fluid retention, which may lead to pulmonary and peripheral edema. Both abnormalities can impair the functional capacity and quality of life of affected individuals. In addition, by its very nature, heart failure is a progressive disorder.

[...] Outpatient Treatment of Heart Failure The goals of outpatient management of patients with symptoms of heart failure due to systolic dysfunction of the left ventricle are the control of fluid retention, the control of neurohormonal activation (to reduce morbidity and mortality), and the control of symptoms and disability. GENERAL MEASURES Several general measures are advisable for most patients with chronic heart failure. Obese patients should lose weight, smokers should stop using tobacco products, and those concomitant cardiac conditions and risk factors (e.g., hyperlipidemia) should have their conditions actively managed. [...]

[...] DRUGS USED TO RELIEVE SYMPTOMS AND LESSEN DISABILITY Digitalis The digitalis glycosides exert their effects in patients with heart failure by virtue of their ability to inhibit sodium-potassium adenosine triphosphatase , -ATPase). Inhibition of this enzyme in the heart results in an increase in cardiac contractility, and for many decades, the benefits of digitalis in heart failure were ascribed to this positive inotropic action. However, by inhibiting Na+ , -ATPase in vagal afferents, digitalis acts to sensitize cardiac baroreceptors, which, in turn, reduce the outflow of sympathetic impulses from the central nervous system. [...]

[...] In the Valsartan Heart Failure Trial (Val-HeFT), the angiotensin II antagonist valsartan was shown to reduce the risk of death or hospitalization for heart failure in patients not receiving an ACE inhibitor, but had little effect when added to patients already receiving an ACE inhibitor and may have exerted an adverse effect in patients receiving both an ACE inhibitor and ß-blocker. Accordingly, angiotensin II receptor antagonists should not be used for the treatment of heart failure in patients who have no prior exposure to an ACE inhibitor, and these drugs should not be substituted for ACE inhibitors in patients who are tolerating ACE inhibitors without difficulty. [...]

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