If the major problem is decreased cardiac output, hydralazine may be given to decrease afterload. If the patient is dyspneic, the addition of isosorbide dinitrate will decrease pulmonary capillary wedge pressure and pulmonary congestion. In patients receiving combination digoxin-diuretic ACE inhibitor therapy who are not hemodynamically stable, hydralazine and isosorbide dinitrate may be added to the regimen, and consideration should be given to cardiac transplantation. Decrease the dose in patients with impaired renal function. The effect of digoxin on mortality in CHF has not been proved, but large scale trials are underway.
Onset of action is immediate and stops quickly when the infusion is discontinued.
May cause tachycardia, angina, and ventricular arrhythmias. Some calcium-channel blockers, especially verapamil and diltiazem, are relatively potent negative inotropic agents and should generally be avoided in patients with poor LV function. The use of beta-blockers in patients with CHF caused by systolic dysfunction is gaining favor but is not yet standard of care. Patients with a previous history of embolism or atrial fibrillation are at high risk for thromboembolic complications and should be considered for warfarin therapy, unless a contraindication exists. All rights reserved.