- General measures
- Restrict salt intake
- Avoid NSAIDs
- Immunize against influenza and pneumococcal pneumonia
- Diuretics
- Use in volume-overloaded pts
- Weigh daily to adjust dose
- For diuretic resistance, administer IV or use two diuretics in combination (e.g., furosemide plus metolazone)
- ACE inhibitor or angiotensin receptor blocker
- For all pts with LV systolic heart failure or asymptomatic LV dysfunction
- Contraindications: Serum K+ >5.5, advanced renal disease (e.g., creatinine >3 mg/dL), bilateral renal artery stenosis, pregnancy
- Beta blocker
- For pts with symptomatic or asymptomatic heart failure and LVEF <40%, combined with ACE inhibitor and diuretics
- Contraindications: Bronchospasm, symptomatic bradycardia or advanced heart block, unstable heart failure
- Aldosterone antagonist
- Consider for class II-IV heart failure and LVEF <35%
- Avoid if K+ >5.0 or creatinine >2.5 mg/dL
- Digitalis
- For persistently symptomatic pts with systolic heart failure (especially if atrial fibrillation present) added to ACE inhibitor, diuretics, beta blocker
- Other measures
- Consider combination of hydralazine and oral nitrate if not tolerant of ACE inhibitor/ARB, and as additive therapy in African-Americans
- Consider ivabradine for LVEF ≤35%, if in sinus rhythm, rate >70, already on maximum tolerated beta blocker, or if contraindication to beta blocker
- Consider ventricular resynchronization (biventricular pacemaker) for pts with class III-IV heart failure, LVEF <35%, and prolonged QRS (especially LBBB with QRS ≥150 msec)
- Consider implantable cardioverter-defibrillator in pts with class II-III heart failure and ejection fraction <35%
- Assess and treat sleep apnea
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