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the basis of maintenance therapy: indicated for all classes of heart failure. They improve symptoms and prolong survival by decreasing preload, afterload and counteracting remodelling
loop diuretics and/or thiazides are used often for symptomatic treatment. Whereas spironolactone (an aldosterone receptor antagonist) is used in the treatment of the late stages of heart failure.
decrease the neurohumoral response and are used (if not contraindicated) with all stable patients with left ventricular dysfunction.
Angiotensin II receptor antagonists
indicated for all classes of heart failure when ACE-inhibitors are not tolerated.
Cardiac glycosides (digoxin)
are used when there is insufficient response to standard therapy, or in cases of atrial fibrillation and a high ventricular response. This positive inotrope improves cardiac output.
No or little complaints?
ACE-inhibitor, diuretic, and beta-blocker.
addition of a diuretic, preferably spironolacton and/or digoxin.
addition of nitrates and hydralazine.