Comprehensive Therapy

, Volume 32, Issue 4, pp 218–225

Treatment of heart failure with decreased left ventricular ejection fraction

Original Articles

DOI: 10.1007/BF02698066

Cite this article as:
Aronow, W.S. Compr Ther (2006) 32: 218. doi:10.1007/BF02698066

Original Article

Class I recommendations for treating patients with current or prior symptoms of heart failure with reduced left ventricular ejection fraction (LVEF) include using diuretics and salt restriction in individuals with fluid retention. Use angiotensin-converting enzyme (ACE) inhibitors, beta blockers, and angiotensin II receptor blockers if intolerant to ACE inhibitors because of cough or angioneurotic edema. Nonsteroidal anti-inflammatory drugs, most antiarrhythmic drugs, and calcium channel blockers should be avoided or withdrawn. Exercise training is recommended. Implant cardioverter-defibrillator (ICD) is recommended in individuals with a history of cardiac arrest, ventricular fibrillation, or hemodynamically unstable ventricular tachycardia. ICD is indicated in patients with ischemic heart disease for at least 40 d post-myocardial infarction or nonischemic cardiomyopathy, an LVEF of 30% or less, New York Heart Association (NYHA) class II or III symptoms on optimal medical therapy, and an expectation of survival of at least 1 yr. Cardiac resynchronization therapy should be used in individuals with an LVEF of 35% or below, NYHA class III or IV symptoms despite optimal therapy, and a QRS duration greater than 120 ms. An aldosterone antagonist can be added in selected patients with moderately severe to severe symptoms of heart failure who can be carefully monitored for renal function and potassium concentration (serum creatinine should be ≶2.5 mg/dL in men and ≶2.0 mg/dL in women; serum potassium should be <5.0 mEq/L).


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Copyright information

© ASCMS 2006

Authors and Affiliations

  1. 1.Divisions of Cardiology, Geriatrics, and Pulmonary/Critical Care Medicine, Department of MedicineNew York Medical CollegeValhalla
  2. 2.Cardiology DivisionNew York Medical CollegeValhalla

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