LV systolic dysfunction	ACE inhibitor	Diuretic	Beta-blocker	Inotropic agents	Vasodilator (hydralazine/ isosorbide dinitrate)	Angiotensin II receptor antagonist	Aldosterone antagonists	Potassium-sparing diuretic
Asymptomatic LV dysfunction	Indicated	Not indicated	Post MI	With atrial fibrillation	Not indicated	Not indicated	Not indicated	Not indicated
Symptomatic LV dysfunction	Indicated	Indicated if fluid retention	Indicated	(a) When atrial fibrillation (b) When improved from more severe heart failure in sinus rhythm	If ACE inhibitors and angiotensin II antagonists are not tolerated	If ACE inhibitors are not tolerated and not on beta-blockade	Not indicated	If persistent hypokalaemia
Worsening heart failure	Indicated	Indicated, combination of diuretics	Indicated (under specialist care)	Indicated	If ACE inhibitors and angiotensin II antagonists are not tolerated	If ACE inhibitors are not tolerated and not on beta-blockade	Indicated	If persistent hypokalaemia
End-stage heart failure	Indicated	Indicated, combination of diuretics	Indicated (under specialist care)	Indicated	If ACE inhibitors and angiotensin II antagonists are not tolerated	If ACE inhibitors are not tolerated and not on beta-blockade	Indicated	If persistent hypokalaemia
Table 1. Left ventricular systolic dysfunction – choice of pharmacological therapy [Remme and Swedberg, 2001]