| Pharmacologic management of heart failure caused by systolic dysfunction. | |
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MedLine Citation:
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PMID: 18441861 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Heart failure caused by systolic dysfunction affects more than 5 million adults in the United States and is a common source of outpatient visits to primary care physicians. Mortality rates are high, yet a number of pharmacologic interventions may improve outcomes. Other interventions, including patient education, counseling, and regular self-monitoring, are critical, but are beyond the scope of this article. Angiotensin-converting enzyme inhibitors and beta blockers reduce mortality and should be administered to all patients unless contraindicated. Diuretics are indicated for symptomatic patients as needed for volume overload. Aldosterone antagonists and direct-acting vasodilators, such as isosorbide dinitrate and hydralazine, may improve mortality in selected patients. Angiotensin receptor blockers can be used as an alternative therapy for patients intolerant of angiotensin-converting enzyme inhibitors and in some patients who are persistently symptomatic. Digoxin may improve symptoms and is helpful for persons with concomitant atrial fibrillation, but it does not reduce cardiovascular or all-cause mortality. Serum digoxin levels should not exceed 1.0 ng per mL (1.3 nmol per L), especially in women. |
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Authors:
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William E Chavey; Barry E Bleske; R Van Harrison; Robert V Hogikyan; Sean K Kesterson; John M Nicklas |
Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: American family physician Volume: 77 ISSN: 0002-838X ISO Abbreviation: Am Fam Physician Publication Date: 2008 Apr |
Date Detail:
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Created Date: 2008-04-29 Completed Date: 2008-06-03 Revised Date: 2009-04-16 |
Medline Journal Info:
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Nlm Unique ID: 1272646 Medline TA: Am Fam Physician Country: United States |
Other Details:
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Languages: eng Pagination: 957-64 Citation Subset: AIM; IM |
Affiliation:
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Department of Family Medicine, University ofMichigan, Ann Arbor, Michigan, USA. wchavey@umich.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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therapeutic use Angiotensin-Converting Enzyme Inhibitors / therapeutic use Digoxin / therapeutic use Diuretics / therapeutic use Heart Failure / drug therapy*, physiopathology* Humans Hydrazines / therapeutic use Isosorbide Dinitrate Severity of Illness Index Systole / physiology* Vasodilator Agents / therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Diuretics; 0/Hydrazines; 0/Vasodilator Agents; 20830-75-5/Digoxin; 302-01-2/hydrazine; 87-33-2/Isosorbide Dinitrate |
| Comments/Corrections | |
Comment In:
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Am Fam Physician. 2009 Mar 15;79(6):454; author reply 456
[PMID:
19323357
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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