Chronic heart failure: 10 Questions physicians often ask

The key test in the initial evaluation is the standard echocardiogram. Elevated plasma levels of B-type natriuretic peptide strongly suggest underlying cardiac dysfunction in patients with symptoms of heart failure (HF). Consider angiotensinconverting enzyme (ACE) inhibitors and B-blockers for all patients with HF, unless contraindicated. High doses of ACE inhibitors have not been shown to be more effective than lower ones; the goal is to reach target dosages comparable to those used in clinical trials. Angiotensin II receptor blockers do not reduce mortality more effectively than standard doses of ACE inhibitors, which remain first-line agents. Oral coagulation is not routinely recommended for patients with HF, although high-risk patients (such as those with atrial fibrillation) may benefit. Patient education, self-monitoring, and compliance with medication and dietary regimens are vital components of treatment.