[Management of patients with symptoms on effort]

The aim of the treatment of symptomatic cardiac failure on effort (Classes II and III) is to improve symptoms and functional capacity and to decrease mortality. The management of such patients includes the investigation of causal and/or aggravating factors which require specific treatment. Hygenic-dietetic rules are important with a low salt diet and restriction of water intake. The continuation of mild physical exercise should be encouraged. Medical treatment associates diuretics to reduce congestive symptoms and angiotensin converting enzyme inhibitors to improve survival. This treatment may be completed by the association of digoxin and/or carvedilol depending on the functional outcome. When stabilised, the patient's diuretic should be reduced to the minimal required dose. If patients remain symptomatic on quadruple therapy, they probably require reevaluation in hospital.