How are you going to manage this patients cardiac failure?

In 5 steps,

1) Firstly,
I will exclude reversible causes/ precipitants
        Thyroid dysfunction
        Arrthymias
        Medications e.g. compliance issues, new meds
        Infarction
        Anaemia
        Infection

2) Then I will treat the underlying disease
        Haemochromatosis
        Ischaemia
        Beri-Beri (nutrition)
        Hypertension
        Valvular Disease
        Alcohol

3) Treat the failure
        Non-Pharmacologically
                Low salt diet (less than 200mg day)
                Fluid restriction (1.5 L/day in mild/moderate)
                Exercise
                Social Support/ Education
                Exclude OSA

        Pharmacologically
                Diurectics
                Ace-Inh/ AII blockers
                B-Blockers
                Spironolactone
                +/- Digoxin

        With a device
                        Cardiac Resynchronization Therapy (drug-refractory class III/IV with LVEF 35% or less, LVEDD >60mm and left-sided conduction delay > 150 msec) – MUSTIC trial (impact on mortality remains unknown though)

4) Prevent Deterioration
        Minimise risk factors

5) Consider Transplant/ other surgical options