Treatment of underlaying disease such as hypertension
Frusemide ; 40-160mg OD orally (or higher doses)
Digoxin : When symptoms are mild, slow digitalization is safer and just as effective as the rapid method. If symptoms are moderately severe, the rapid oral method may be used, but the patient should be examined before each dose with particular attention to the cardiac rhythm. An ECG should be recorded if there is any doubt about the nature of the pre-therapy rhythm or changes during digitalization. Intravenous digitalization is rarely required in chronic heart failure; it should be used only in hospitalized patients with careful monitoring.Adults: Rapid digitalization orally: 0.75mg to 1.5mg as single dose followed by maintenance dose. Slow digitalization orally: 0.25-0.75mg daily for about one week, followed by maintenance dose. Maintenance dose: 0.25-0.5mg daily. Children under 10 years: Digitalization; 10-20mcg/kg 6 hourly. Maintenance; 10-20mcg/kg in a single or divided dose. Emergency digitalization; 0.5-1.0mg given by total parental dose slowly.
Potassium supplements: fruits mainly bananas and oranges.
Heparin (as a prophylactic anticoagulant in case of prolonged bed rest) 2,500 IU BD SC.
Where the above treatment is not effective add the following:
Tab Captopril 6.25-12.50mg TID
Tabs Enalapril 2.5-10mg OD or BD
Other drugs not in the EDL (Kenya) include;
Carvedilol: 12.5mg OD, increased after 2 days to 25mg OD. If need be, the dose may be increased to 50mg OD at an interval of at least 2 weeks.
Dietary changes, Cessation of smoking, Physical exercise