Activity Regular exercise should be encouraged for those with stable heart failure, as it may improve functional status and alleviate symptoms. The exercise routine should be tailored to the patient s abilities and may require medical supervision in an appropriate facility. Pharmacotherapy ACE inhibitors improve both the quality of life and survival of heart failure patients and should be considered the cornerstone of heart failure medical treatment whenever possible. Use of these agents is contraindicated for patients with a history of hypersensitivity and should be used with great caution when hyperkalemia or renal insufficiency is present. Development of a dry cough is a common side effect.
Diuretics are of benefit when signs of volume overload are present.
The dosage should be carefully adjusted to a level that effectively removes excess fluid without causing volume depletion. Serum potassium should be monitored and corrected when necessary by supplementation or increased dietary intake. Diuretics are often incorporated in a combined formulation with ACE inhibitors, potassium sparing agents and beta blockers. Digoxin may be added to the regimen of patients in whom symptoms are not adequately controlled with ACE inhibitors and diuretics. Vasodilators such as isosorbide dinitrate or hydralazine may also be useful in these patients.