Management of Heart Failure

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Alternatives to ACE Inhibitors.

For patients who are intolerant of ACE inhibitors, alternative medications are available. The combination of hydralazine and nitrates also decreases mortality for patients with systolic dysfunction HF. Angiotensin II receptor antagonists (A II)
are another promising alternative therapy for patients who cannot use ACE inhibitors. Current clinical trials will help clarify the role of these drugs alone or in combination with an ACE inhibitor. Angiotensin II blocking drugs do not affect bradykinin
levels and thus do not induce angioedema and cough to the same extent as ACE inhibitors. The first and second generation calcium channel blockers such as nifedipine, diltiazem, and nicardipine may worsen systolic dysfunction symptoms due to negative inotropic effects and a tendency to increase sympathetic tone. In one large trial (PRAISE-1), amlodipine did not increase mortality among patients with HF due to nonischemic cardiomyopathy. Although dihydropypridine calcium channel blockers should not be used as specific primary treatment for systolic dysfunction HF, amlodipine can be considered for patients with continued hypertension on ACE inhibitors and diuretics or those with symptomatic ischemia not controlled by nitrates and/or beta-blockers.


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what is the explanation for orthopnoea in CCF




Physical inactivity is a major risk factor for heart disease and stroke and is linked to cardiovascular mortality. Regular physical activity can help control blood lipid abnormalities, diabetes and obesity. Aerobic physical activity can also help reduce blood pressure. The results of pooled studies show that people who modify their behavior and start regular physical activity after heart attack have better rates of survival and better quality of life. Healthy people as well as many patients with cardiovascular disease can improve their fitness and exercise performance with training.


very informative article !!!

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