CHF patient with depressed ejection fraction USMLE HYT


ACE inhibitors and betablockers are the basic regimen for patients with CHF and a depressed ejection fraction. The addition of spironolactone has been shown to be beneficial in management of CHF in patients with New York Heart Association Class III or IV heart failure and an ejection fraction less than 35%. NYHA Class III patients have marked limitation, with symptoms on less than usual activities. NYHA Class IV patients are dyspneic at rest. Although aspirin, warfarin, or amlodipine may be given for other indications, they are unlikely to improve his CHF symptoms. The combination of hydralazine and isosorbide dinitrate has been shown to be advantageous in African Americans who remain symptomatic on ACEIs and beta-blockers


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