1. Long-term use of beta-blockers in patients with end-stage HF may improve LV function and increase survival. The mechanisms responsible for this beneficial effect may derive from opposition to the toxic effects of persistent catecholamine secretion.

2. Carvedilol (Coreg) is the only beta-blocker that is FDA-approved for systolic dysfunction. Carvedilol reduces symptoms and improves LV function and also appears to improve survival.

3. Beta-blockers should be reserved for patients who do not respond to more traditional agents. In addition, if a beta-blocker is used for HF with systolic dysfunction, it must be started at a low dose and titrated exceedingly slowly over a period of months. Symptoms may initially worsen before they improve. Beta-blockers are a treatment of choice for

HF from diastolic dysfunction. Beneficial effects include a slowed heart rate and increased cardiac output.

References: See page 195.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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