Congestive heart failure. Considerations for primary care physicians.

Initial evaluation of congestive heart failure (CHF) should emphasize a search for curable and precipitating causes. Echocardiography is mandatory if CHF is a serious consideration after initial evaluation. Digitalis, diuretics, and vasodilators in the form of angiotensin-converting enzyme (ACE) inhibitors are the mainstays of pharmacologic therapy. Early use of ACE inhibitors for asymptomatic left ventricular dysfunction and established CHF lessens morbidity and mortality. The number of expensive hospitalizations can be reduced by patient education and institution of a flexible therapeutic program guided by the patient's symptoms and daily weigh-ins.