PMID- 1626487
OWN - NLM
STAT- MEDLINE
DCOM- 19920813
LR  - 20190622
IS  - 0002-9149 (Print)
IS  - 0002-9149 (Linking)
VI  - 69
IP  - 18
DP  - 1992 Jun 4
TI  - Management of refractory congestive heart failure.
PG  - 141G-147G; disc. 147G-149G
AB  - Despite recent advances in the treatment of congestive heart failure (CHF), many 
      patients continue to present with symptoms refractory to digoxin, diuretic, and 
      vasodilatory therapy. Since it is unlikely that this population will decrease in 
      the near future, practical approaches to management of refractory CHF are 
      reviewed. Refractory CHF here is defined as New York Heart Association (NYHA) 
      functional class III-IV heart failure, despite maximal drug therapy. Before such 
      a diagnosis is made, the patient should be treated with digoxin, diuretics, and a 
      vasodilator. Approach to therapy requires assessment of changing clinical status 
      and pathophysiology, optimizing oral drug treatment, and providing temporary 
      parenteral support when indicated. Specific attention should be given to factors 
      that influence the optimal response to each of these 3 treatment classes. A 
      theoretical, but unproven, concept suggests that combined vasodilatory therapy 
      may be appropriate as long as excessive hypotension is avoided. In the course of 
      management, a decision is required as to whether further optimization of therapy 
      can be achieved on an outpatient basis. Hospital-based intravenous inotropic 
      support given for 2-4 days will often provide the opportunity to restructure 
      patient therapy.
FAU - Cody, R J
AU  - Cody RJ
AD  - Department of Medicine, Ohio State University College of Medicine and Hospitals, 
      Columbus.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Diuretics)
RN  - 0 (Vasodilator Agents)
RN  - 73K4184T59 (Digoxin)
SB  - IM
MH  - Administration, Oral
MH  - Digoxin/therapeutic use
MH  - Diuretics/therapeutic use
MH  - Drug Therapy, Combination
MH  - Heart Failure/diagnosis/*drug therapy/physiopathology
MH  - Humans
MH  - Infusions, Intravenous
MH  - Vasodilator Agents/therapeutic use
RF  - 27
EDAT- 1992/06/04 00:00
MHDA- 1992/06/04 00:01
CRDT- 1992/06/04 00:00
PHST- 1992/06/04 00:00 [pubmed]
PHST- 1992/06/04 00:01 [medline]
PHST- 1992/06/04 00:00 [entrez]
AID - 0002-9149(92)91262-3 [pii]
AID - 10.1016/0002-9149(92)91262-3 [doi]
PST - ppublish
SO  - Am J Cardiol. 1992 Jun 4;69(18):141G-147G; disc. 147G-149G. doi: 
      10.1016/0002-9149(92)91262-3.