Heart failure clinical presentation

C. Clinical Role ANP has been studied for possible use in the treatment of congestive heart failure, but results have been mixed. BNP has showed some benefit in small studies in patients with heart failure. At present there are no clinically important products that act as agonists or antagonists at atrial natriuretic peptide receptors. 

In clinical trials, ATI antagonists have proven to be as effective as ACE inhibitors in hypertension, congestive heart failure, and renal failure [3]. The favorable side effect profile of ATI antagonists argues for a greater use of these diugs. At present, due to still higher costs, they are indicated in patients who do not tolerate ACE inhibitor treatment. 

CLINICAL PRESENTATION AND DIAGNOSIS OF CHRONIC HEART FAILURE... 

Clinical Presentation and Diagnosis of Acute Heart Failure... 

STE ACS, class I recommendation within the first 24 hours after hospital presentation for patients with anterior wall infarction, clinical signs of heart failure and those with EF less than 40% in the absence of contraindications, class I la recommendation for all other patients in the absence of contraindications. 

A 57-year-old African-American man presents to the clinic for follow-up management of UC. He has had left-sided disease for 3 years and has been maintained in remission on maximal doses of oral mesalamine and prednisone 35 mg orally once daily. His provider has attempted several times to taper the prednisone dose, but the patient experiences a reappearance of symptoms if the dose is lowered below this level. Medical history is also significant for hypertension and heart failure. He has no known drug allergies. 

FIGURE 8-2. General treatment algorithm for acute decompensated heart failure (ADHF) based on clinical presentation. IV vasodilators that may be used include nitroglycerin, nesiritide, or nitroprusside. Metolazone or spironolactone may be added if the patient fails to respond to loop diuretics and a second diuretic is required. IV inotropes that may be used include dobutamine or milrinone. (D/C, discontinue HF, heart failure SBP, systolic blood pressure.) (Reprinted and adapted from J Cardiac Fail, Vol 12, pages el-el 22, copyright 2006, with permission from Elsevier.)... 

Most clinical trials have been carried out in patients with systolic dysfunction, so the evidence regarding the superiority or inferiority of drugs in heart failure with preserved ejection fraction is meager. Most authorities support the use of the drug groups described above. Control of hypertension is particularly important, and revascularization should be considered if coronary artery disease is present. Tachycardia limits filling time therefore bradycardic drugs may be particularly useful, at least in theory. 

Aliskiren is presently being evaluated in the ASPIRE HIGHER clinical trial program in more than 35,000 patients in 14 trials to study the effect of renin inhibition on outcomes in patients with conditions such as heart failure and diabetes as well as on organ protection benefit in a variety of disease states.25 To date, three of the short-term trials with organ protection endpoints have reported findings. In patients with type 2 diabetese, kidney disease, and high blood pressure, the AVOID (Aliskiren in the Evaluation of Proteinuria in Diabetes) study has demonstrated that aliskiren provides additional kidney protection when added to the maximum dose of the ARB losartan.26 In... 

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