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Heart Failure Treatment

From Mediwikis
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Lifestyle

  • Cardiac rehabilitation programme
  • Smoking Cessation
  • Alcohol Abstinence
  • Salt & Fluid restriction

Medication Classes

  • ACE Inhibitors (Or switch to Angiotensin Receptor Blocker if ACEI symptoms)
  • β-Blockers
  • Diuretics
  • Spironolactone
  • Digoxin
  • Nitrates

Treatment Guidelines

1) Symptomatic Treatment

  • Loop Diuretics - e.g. furosemide helps relieve symptoms of SOB (Monitor K+!! If too low might need to switch to Spironolactone)
  • K+ Sparing Diuretics (use instead of furosemide OR in addition to existing medication if refractory to optimal therapy)
  • Digoxin - digoxin, a positive inotrope, helps to increase cardiac output and therefore relieves symptoms (**Tend to use in patients with AF**)

2) Treatment for Prognosis

  • ACEI/ARB - Improves symptoms AND prognosis (due to Increase in Left Ventricular Ejection Function & Vasodilatation)
  • B Blockers (e.g. cardevilol) - improves symptoms AND prognosis (by controlling ventricular rate)
  • Angiotensin II receptor blocker or aldosterone antagonist are next line if ACEi/BBlocker are not effective enough.
  • Vasodilators e.g. nitrates/hydralazine - Consider adding this to existing therapy OR if intolerant to ACEI.
  • Newer drugs like Ibravadine can be prescribed by specialists. Large RCT has shown reduced hospitalisation & cardiovascular morbidity (According to NICE Guidelines, indicated in moderate or severe heart failure)
  • Primary prevention doses of antiplatelet therapies and statin - aspirin/clopidogrel/atorvastatin

Adverse Effects

ACE Inhibitors

  • Hypotension
  • Dry Cough (Shared receptor in lung tissue)
  • Rash
  • Taste disturbance
  • Hyperkalaemia (careful when used together with Spironolactone!)
  • Renal impairment
  • Congenital malformation

β-Blockers

  • Bronchospasm- do NOT use in asthma!
  • Hypoglycaemia
  • Postural Hypotension
  • Diarrhoea, Nausea, Dyspnoea, Heart block, sexual dysfunction

Monitoring of Treatment

Monitor when starting treatment, and when changing anything. Assess adverse effects, plus:

  • Potassium
  • Sodium
  • Urea
  • eGFR
  • Creatinine