PRACTICAL CHALLENGES

Case histories for three patients with heart failure were presented to an audience of cardiologists, general physicians, geriatricians and other specialists. The delegates responded via key pads to questions concerning management of the patients. The value of noninvasive investigations (eg, chest X-ray, electrocardiogram, echocardiogram, exercise test) in establishing the diagnosis, management and prognosis was demonstrated. Most delegates indicated that they would prescribe angiotensin converting enzyme (ACE) inhibitors in mild to moderate heart failure, although low doses were preferred to high doses in elderly patients. The importance of avoiding nonsteroidal anti-inflammatory drugs in patients on ACE inhibitor therapy was illustrated.