Modern trends in the management of heart failure.

An increasing number of medications are available to the physician treating heart failure. Initial therapy involves diuretics, with digitalis, vasodilators, and anticoagulants used for progressive disease. Additional medications such as the phosphodiesterase inhibitors offer promise for the future. In selected patients, the results of heart transplantation have been extremely gratifying and frequently can return the patient with end-stage heart failure to a near-normal life-style. The physician should be mindful that most patients with heart failure need frequent attention and evaluation. Many patients with moderate to severe heart failure require multidrug regimens and close surveillance to detect electrolyte imbalance or evidence of decompensation at an early stage. Often a tenuous balance exists between pulmonary vascular congestion and orthostatic hypotension, and week-to-week or day-to-day titration of diuretic and vasodilator therapy is required. While the care of the patient with heart failure often requires considerable time and resources, judicious treatment can lead to dramatic improvement and is frequently rewarding to both the patient and physician.