Initiation of carvedilol at this time is reasonable. Carvedilol was initiated at 3. 125 mgs bid. Three days later the patient called with weight gain of 3 lb. and increased dyspnea. The patient is experiencing the slight worsening of heart failurefthat commonly occurs during carvedilol initiation.
Volume overload is suspected.
Compliance with diet and fluid restriction should be encouraged. Diuretics should be temporarily increased. Diuretic doses can usually be returned to maintenance levels following resolution of volume excess. Lasix dose was doubled for two days with weight loss and resolution of Sx. At the second clinic visit the exam was unchanged from baseline.