Current trends in the primary care management of chronic congestive heart failure.

Congestive heart failure affects over 2.3 million Americans; approximately 400,000 new cases are diagnosed yearly in this country. Congestive heart failure is a complex disorder with a poor long-term prognosis. The major causes of congestive heart failure are ischemia, infarction, and idiopathic cardiomyopathy. Patients often present with dyspnea and a low exercise tolerance. In congestive heart failure there may be an alteration in preload, afterload, and contractility of the heart. Many compensatory mechanisms occur to support the failing heart. Cardiac symptoms slowly develop and eventually systemic symptoms develop. The cornerstones of pharmacologic therapy are cardiac glycosides, diuretics, and angiotensin-converting enzyme inhibitors.