TX of HF

Little HF patho reminder

  • ↓ CO ➔ activation of RAAS

    • ↑ volume (reabsorbing salt and H2O follows) ➔ ↑ preload

    • vasoconstriction (↑ peripheral resistance) ➔ ↑ afterload

    • BNP counteracts the activation of RAAS

    • BNP is broken down by Neprilysin

HF TX (general)

  • Tx underlying DZ (CAD, HTN, DM, valvular dz, cardiomyopathy, thyroid)

  • Lifestyle modification with daily weight monitoring (5lb weight ↑ ➔ double diuretic dose)

    • Quit smoking and etOH, avoid NSAIDs

    • Na restrict to <3g/day

  • Everyone gets β-blocker and ACEi or ARB (only carvedilol, bisoprolol, metoprolol are indicated in HF)

  • Ischemic/CAD: add on ASA and statin

  • Class II (activity/exercise ➔ SSX): probably due to fluid ➔ loop diuretics

  • CLASS III (comfortable only at rest): spironolactone, hydralazine/isosorbide dinitrate (BiDil)

  • EF <35%: AICD (Automated Internal Cardioverter/Defibrilator), NYHA 2 or 3 that don't respond to meds

  • Class IV: milrinone or dobutamine (while waiting for LVAD/transplant)

Things to include in chart:

  • NYHA class

  • Etiology (ischemic)

  • EF and how

  • Baseline edema

  • Cr, Hgb, K, dry BNP

  • Dry weight