In this instance verapamil, diltiazem or a beta blocker may be considered. G. Anticoagulant Therapy Anticoagulant therapy is strongly recommended in all patients in whom there is co-existent atrial fibrillation and heart failure. It is not routinely required in the presence of heart failure and sinus rhythm but might be considered if other risks for arterial or venous thrombosis exist or an intracardiac thrombus has been demonstrated. This is particularly useful in patients with demonstrated ischemia and viable myocardium. At present, cardiomyoplasty is an experimental technique whose subsequent role remains to be defined.
Transplantation is a viable option in the management of end stage heart failure.
Due to the shortage of donor hearts, both the selection criteria and contraindications for heart transplantation should guide Canadian centres in selecting the appropriate candidates for transplantation. The algorithm shown in Figure 1 provides a reasonable approach to the management of heart failure. In acute heart failure consider the possible precipitating factors listed in Table I. 2. If hypotension develops during the course of therapy with diuretics and ACE inhibitors, the dose of diuretics should be reduced rather than the dose of ACE inhibitor. In many instances, the same is true for apparent worsening of renal failure.