0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53
322 Chronic Heart Failureexacerbate heart failure (NSAIDs, calcium channel blockers, anti-
arrhythmics), treat hemochromatosis, sarcoidosis, amyloidosis,
pericardial disease hypertension
■Maintain fluid balance:
➣Restrict salt intake (≤3 g salt/d)
➣Daily weights (same time of day, post-voiding, nude)
■Improve physical conditioning: encourage moderate degrees of exer-
cise to prevent/reverse deconditioning
■Specific measures
➣Control ventricular response in atrial fibrillation or other SVT
➣Anti-coagulation in atrial fibrillation or previous embolic event
➣Coronary revascularization in patients with angina or if survival
benefit anticipated
■Avoid certain medications
➣Anti-arrhythmic agents to suppress asymptomatic ventricular
arrhythmias
➣Most calcium channel blockers
➣Nonsteroidal anti-inflammatory drugs
■Other general measures include influenza and pneumococcal vac-
cination, close outpatient surveillancespecific therapy
Treatment Options, including Side Effects and Contraindications: Gen-
eral information on drug classes, check for more complete prescrib-
ing information, see also Chapter on Hypertension and Acute Heart
Failure
■Approved Therapies:
■Diuretics: thiazides (hydrochlorothiazide), loop diuretics (furo-
semide, torsemide, bumetanide), metolazone, potassium-sparing.
If patient–properly instructed and motivated, may use a prn dose
for transient increases in body weight.
➣Indication: Volume overload, reduce preload. Thiazides or meto-
lazone alone in mild fluid retention, loop diuretics in most
patients (mild-severe); metolazone and loop diuretic in severe
cases. Rapidly improve symptoms.
➣Side Effects and Complications: renal failure, thrombocytopenia,
orthostatic hypotension, dizziness, dry mouth, headache, nau-
sea/vomiting, dyspepsia, impotence, rash, hypokalemia, muscle
cramps, ototoxicity.
➣Absolute Contraindications: hepatic coma
➣Relative Contraindications: anuria, severe electrolyte depletion