Management of Congestive Heart Failure (CHF):

• ACE inhibitors (e.g., ramipril): First-line treatment to reduce symptoms and improve survival, particularly beneficial for diabetic patients.
• Beta-blockers: Added to the regimen if symptoms persist after initiating ACE inhibitors.
• Spironolactone: Added if symptoms persist despite optimal doses of ACE inhibitors (or ARBs) and beta-blockers. For long term management.
• Diuretics (e.g., furosemide): For symptomatic relief and to reduce volume overload.

 

• Special Considerations:

1. Diabetes: Start with ACE inhibitors due to their reno-protective properties.
2. Heart Failure with Atrial Fibrillation (HF + AF): Consider adding digoxin.