Congestive Heart Failure
		Signs and Symptoms
		Left sided heart failure: dyspnea on exertion, orthopenia, tachypnea, cough, rales, pulmonary edema, pleural effusion, S3 gallops
		Right sided heart failure: abdominal pain, nausea, anorexia, bloating, ascites, peripheral edema, hepatojugular reflux
		Classification of Congestive Heart Failure (NYHA)
		Class		Presentation
		Class I		symptoms only on strenuous exertion
		Class II		asymptomatic on rest, symptomatic with normal activity
		Class III		asymptomatic on rest, very symptomatic with minimal activity
		Class IV		symptomatic at rest, increases with activity
		Treatment Guidelines (Systolic Congestive Heart Failure)
		Place on a sodium restricted diet (2000-3000mg/day)
		Start on loop diuretics (ex. Furosemide) to decrease fluid overload.  Monitor electrolytes and renal function.
		Can add metolazone to help reduce resistance to loop diuretic
		ACE inhibitor therapy should be initiated in all patients with CHF, unless contraindicated
		Angiotension receptor blockers can be employed where ACE inhibitors are not tolerated
		Beta-blockers can be used in NYHA class II or III heart failure
		Digoxin is indicated in patients with CHF and atrial fibrillation (help improve quality of life)
		Hydralazine +/- isosorbide dinitrate can be used where ACE inhibitors are contraindicated
		Spironolactone has been shown to improve symptoms in patients with NYHA class III or IV congestive heart failure
		Anticoagulation is only recommended for patients who had recent atrial fibrillation, recent pulmonary embolism, recent systemic embolism, or mobile left ventricular thrombi
		Treatment Guidelines (Diastolic Congestive Heart Failure)
		Treat the underlying cause of the diastolic heart failure
		Use nitrates and/or diuretics in symptomatic patients (avoid over-diuresis - may lead to hypotension)
		Beta-blockers or calcium channel blockers are useful in allowing ventricles more time to fill
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