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Cardiology

Answer 2
  1. Digoxin significantly improves survival of patients with CHF. Digoxin improves symptoms, quality of life, and functional capacity in patients with mild to moderate CHF, regardless of underlying rhythm, but it does not improve patient survival. Although diuretic use is the only means of enabling salt and water excretion in patients with CHF, these drugs should always be used in conjunction with other agents, usually angiotensin-converting enzyme (ACE) inhibitors and beta-blockers. ACE inhibitors are useful in managing left ventricular systolic dysfunction with or without symptoms of CHF; they favorably affect remodeling and survival. The benefits from a hydralazine-nitrate combination may result from biochemical, antioxidant, and/or vasodilatory effects. However, the 2 drugs are not first-line treatments prior to the use of ACE inhibitors. Because of the risk of death and lack of efficacy data, intravenous infusion of positive inotropic agents is not recommended for outpatients.

    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.

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