Document Detail

Pharmacologic management of heart failure caused by systolic dysfunction.
MedLine Citation:
PMID:  18441861     Owner:  NLM     Status:  MEDLINE    
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.
William E Chavey; Barry E Bleske; R Van Harrison; Robert V Hogikyan; Sean K Kesterson; John M Nicklas
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  American family physician     Volume:  77     ISSN:  0002-838X     ISO Abbreviation:  Am Fam Physician     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-04-29     Completed Date:  2008-06-03     Revised Date:  2009-04-16    
Medline Journal Info:
Nlm Unique ID:  1272646     Medline TA:  Am Fam Physician     Country:  United States    
Other Details:
Languages:  eng     Pagination:  957-64     Citation Subset:  AIM; IM    
Department of Family Medicine, University ofMichigan, Ann Arbor, Michigan, USA.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Digoxin / therapeutic use
Diuretics / therapeutic use
Heart Failure / drug therapy*,  physiopathology*
Hydrazines / therapeutic use
Isosorbide Dinitrate
Severity of Illness Index
Systole / physiology*
Vasodilator Agents / therapeutic use
Reg. No./Substance:
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
Comment In:
Am Fam Physician. 2009 Mar 15;79(6):454; author reply 456   [PMID:  19323357 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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