Heart Failure

  • Fluid overload causing an increased end diastolic pressure
    • #1 Cardiomyopathy – dilated (HTN)
    • #2 Ischemic
    • Valve, viral, genetic
  • Systolic vs Diastolic
  • Right (aka anasarca) vs. Left
  • Systolic: syncope, RF, exercise intolerance
  • Diastolic: edema, effusions, SOB
  • Right: edema, hepatomegaly
  • Left: syncope, RF, effusions



 

Treatment:

  • Preload (increase) – Ted, ambulation, elevate legs to increase venous return
  • Afterload (decrease) – BP
  • Contractility (increase) – dopamine/dobutamine/digitalis; better coordinated AV function (CCB)
    • Renin-Angiotensin –> increased fluid volume, vasoconstriction, eccentric hypertrophy (remodeling)
    • RALES trial – spironolactone
    • BNP – retains water –> furosemide!
  • Spironolactone
  • Lasix (furosemide)
  • Fluid/Na restrict
  • Ambulate and Teds
  • Echo (function)
  • Control BP (acutely)
    • ACEi (ARB)
    • CCB (verapamil, diltiazem) – positive inotrope
    • Diruretics – thiazides
    • Last line is Beta blockers (but used once stable to decrease hospitalizations, not mortality)

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