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Fluids & Electrolytes
Revised heart failure management guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC) affirm current treatment strategies and strengthen previous recommendations. The last guidelines came out in 2001. New or strengthened recommendations include the following:
* Symptoms related to sleep-disordered breathing should be covered in history-taking.
* All stable patients with current or prior symptoms of heart failure and reduced left ventricular ejection fraction (LVEF) should receive one of three beta-blockers: bisoprolol, carvedilol, or sustained-release metoprolol succinate (unless contraindicated).
* Using aldosterone antagonists is reasonable in selected patients, but combining them with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers "cannot be recommended."
* The use of primary prevention with implantable cardioverter-defibrillators along with optimal medications is appropriate for patients with certain clinical characteristics (for example, patients with nonischemic cardiomyopathy and those with ischemic heart disease who are 40 days post-MI, have an LVEF equal to or less than 30%, and are in New York Heart Association class 2 or 3).
For the complete guidelines, visit the Web sites of the AHA (http://www.americanheart.org) and the ACC (http://www.acc.org).
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