Management

Pharmacological therapy is the standard approach in heart failure treatment.1-6'7-1 Angiotensin-converting enzyme (ACE) inhibitors reduce preload and afterload, and wall stress. ACE inhibitors reduce mortality, hospitalization rate, and progression of heart failure, and are indicated for all patients with systolic LV dysfunction. Angiotensin II receptor antagonists have equal effects on symptoms but without the bradykinin-related side effects of ACE inhibitors. Reduction in mortality has been shown for these drugs. The major advancement in heart failure therapy is the use of low-dose ß-adrenergic blockers. The effect of ß-blockade on mortality is additional to the effect of ACE inhibitors, and benefit is independent of the severity of heart failure. Digitalis is a positive inotropic agent and provides symptomatic benefit without effect on mortality. Diuretics are indicated in symptoms of volume overload despite the use of ACE inhibitors and digitalis. Spironolactone is a potassium-sparing diuretic agent and has been shown to reduce mortality. First-generation calcium channel antagonists are contraindicated in standard treatment guidelines in heart failure because they reduce survival rate and exacerbate symptoms.

Anticoagulants or antiplatelet agents are recommended in LV ejection fraction less than 30%. Atrial fibrillation requires chronic anticoagulation.

Cardiac resynchronization with biventricular pacing improves symptoms in advanced heart failure. Patients with impaired systolic function and at high risk for SCD benefit from biventricular pacing properties of an implantable cardioverter defibrillator (ICD). Implantable cardioverter defibrillator implantation is recommended in LMNA mutation carriers. Higher-degree atrioventric-ular conduction defect requires pacemaker therapy. Benefits of LV assist devices are tempered by a high complication rate. Heart transplantation in end-stage disease improves survival and quality of life. Monitored physical conditioning with general education improves exercise capacity and quality of life.

Getting Started With Dumbbells

Getting Started With Dumbbells

The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.

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