DIAGNOSIS AND OUTPATIENT MANAGEMENT OF CONGESTIVE-HEART-FAILURE

Congestive heart failure causes substantial patient morbidity and mort ality in the United States. Symptoms and physical findings can be help ful in diagnosis but have limited sensitivity and specificity, Objecti ve measurement of ventricular function is essential in virtually all p atients in whom a diagnosis of heart failure is suspected, Reversible causes of heart failure must be sought. Outpatient management includes education and counseling, emphasis on and assessment of compliance wi th diet, acid pharmacologic treatment. Angiotensin-converting enzyme i nhibitors are the mainstay of treatment but are underused, and maximal doses are not given apparently because of concern about side effects, Diuretic therapy should be administered only as needed to manage flui d overload. Calcium channel blockers are relatively contraindicated in patients with impaired ventricular function, Patient follow-up should be guided by the results of the medical history and physical examinat ion, Routine serial testing of ventricular function and exercise perfo rmance is discouraged.