- 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)