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Answer 4
  1. ß-Blocker. ß-blocker therapy is now a mainstay of treatment for CHF.2 However, ß-blocker therapy initially worsens left ventricular function and should not be initiated until the patient is euvolemic. Intravenous diuresis is often needed for the decompensated patient because gut edema decreases the absorption of oral medications. ACE inhibitors are a required component of therapy and unequivocally improve survival in CHF patients.3 Digoxin does not improve survival but does decrease symptoms and reduces rehospitalization rates. Frequent monitoring and aggressive replacement of potassium and magnesium is essential to minimize the risk of ventricular arrhythmias.

     Lechat P, Packer M, Chalon S, et al. Clinical effects of beta-adrenergic blockade in chronic heart failure: a meta-analysis of double-blind, placebo-controlled, randomized trials. Circulation 1998;98:1184-91.
    3. Garg G, Yusuf S. Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials [published erratum in JAMA 1995;273:462]. JAMA 1995;273:1450-6.

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