Heart Failure Treatment Heart Failure GENERAL PRINCIPLES

 

HeartAcute Myocardial Infarction CLINICAL PRESENTATION. Read more ... » Failure TreatmentARKA Calotropis procera Ayurvedic Medicine for piles and Anal Fistula. Read more ... » PHARMACOLOGICAL THERAPY

Heart failureHeart Failure Causes Symptoms NYHA classification with Heart Failure Treatment. Read more ... » (HF) is a common clinicalARKA Calotropis procera Ayurvedic Medicine for piles and Anal Fistula. Read more ... » syndrome representing the end-stage of a number of different cardiacACTH and TSH DEFICIENCY Diagnosis with Treatment. Read more ... » diseases.

Heart failure may result from arrhythmiasSupraventricular tachycardia and Ventricular fibrillation Causes Diagnosis with Treatment. Read more ... », heart valve lesions,myocardial infarction, myocardial ischemiaIschemia Myocardial ischemia(MI) ECG and effects of ischemia. Read more ... »,  congenital malformation of the heart or great vessels, pericarditisCOMPLICATIONS OF Acute Myocardial Infarction (AMI) AND TREATMENT -2. Read more ... », cardiomyopathyCardiomyopathy Clinical features Etiology Diagnosis Dilated Hypertrophic Restrictive cardiomyopathy with Treatment. Read more ... », constrictive or conditions that affect the heart indirectly,

 

Heart Failure GENERAL PRINCIPLES —

• The managementChronic Renal Failure (CRF) Risk factors Causes Stage CRF Treatment. Read more ... » of HF begins with an accurate assessment of the etiology and severity of the diseaseARKA Calotropis procera Ayurvedic Medicine for piles and Anal Fistula. Read more ... »

 

ACE Inhibitors (Angiotensin converting enzyme inhibitors) in Heart Failure

• · First line therapy of CHF
• · All cases with less than 40% LVEF (left ventricular ejection fraction)
• · Reduce risk of MI
• · Must be given after MI in any case
• · Improve systolic function
• · Prevent decompensation
• · Prevent sudden death
• · With or without symptomsARKA Calotropis procera Ayurvedic Medicine for piles and Anal Fistula. Read more ... »
• · Uptitrated gradually to doses recommended
• · Relieve symptoms
• ·Improve functional capacity

 

Adverse effects of ACE Inhibitors -

• · Cough
• · HypotensionDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... »
• · Hyperkalemia
• · Angioedema
• · RenalDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... » insufficiency
• · Syncope.

 

Contraindications of ACE Inhibitors -

• · Pregnancy
• · Bilateral renal artery stenosis
• · Angioedema
• · Serum creatinine> 3.

 

Precautions with ACE Inhibitors -

• 1. Monitoring of renal function
• 2. Serum electrolytes monitored
• 3. Avoid potassium sparing diuretics
• 4. Avoid NSAIDs (Non steroidal anti-inflammatory drugs)
• 5. Avoid diuretics + vasodilators together.

 

Dose of ACE Inhibitors -

• Enalapril 10 mg BD
• Lisinopril 5 – 35 mg OD
• Captopril 50 mg TDS
• Ramipril 5mg BD.

 

ARBS (ANGIOTENSIN RECEPTOR BLOCKERS)

• · Alternative to ACE inhibitors
• · Same efficacy, Reduce mortality and morbidity
• · Can be combined with ACE inhibitors with caution

 

DIURETICS in Heart Failure

• · Loop diuretics
• · Thiazides
• · Metolazone.
• If GFR (glomerular filtration rate) <30 ml/min use loop diuretics
• metolazone is used for severe heart failure Potassium-sparing diuretics for hypokalemia
• High doses of diuretics used for fluid retention and dyspnoea.

 

BETA BLOCKERSMANAGEMENT of Acute Myocardial Infarction (AMI) -1. Read more ... » - Why

• · For stable NYHA class II – IV
• Reduces morbidity
• · Improves function
• · Reduces mortality

 

Examples of Beta Blockers ­

• Atenolol
• Metoprolol
• Nebivolol
• · Bisoprolol
• · Carvedilol

 

ALDOSTERONEAldosteronism Clinical features Causes and Treatment. Read more ... » ANTAGONISTS in Heart Failure

• · They come after ACE Inhibitors, beta blockers, diuretics
• · Improves survival and morbidity
• · Useful after MI with LV systolic dysfunction
• · Useful in heart failure + diabetes
• · Exs are spirinolactone, eplerinone
• · Do not cause hypokalemia

 

CARDIAC GLVC:OSIDES should be given in Heart Failure

• · Heart failure
• · Heart failure + atrial fibrillationAtrial fibrillation Causes and Treatment Indications of DC Cardioversion. Read more ... »
• · Heart failure + tachycardia
• · Heart failure with/due to beta blockers
• · Reduces hospitalization
• · Very cheap
• ·Relieves symptoms.

 

Contraindications of digitalis  in Heart Failure -

• · BradycardiaSINUS Bradycardia Bradyarrhythmia Symptoms Causes Diagnosis with Treatment. Read more ... »
• · 2^nd and 3^rd degree AV block
• · SSSSick Sinus Syndrome SSS Symptoms Causes Diagnosis with Treatment. Read more ... » (Sick Sinus SyndromeSick Sinus Syndrome SSS Symptoms Causes Diagnosis with Treatment. Read more ... »)
• · WPW syndrome
• · HOCM (Hypertrophic obstructive cardiomyopathy)
• · Hypokalemia
• · Hyperkalemia
• ·Carotid sinus syndrome.

 

Dosage of digitalis -

• · Daily dose 0.125 – 0.25 mg/day oral
• · IV dose 0.25 – 0.5 mg IV slowly for rapid digita­lization
• · Serum creatinine should be monitored and dose reduced, if high.

 

VASODILATORS in Heart Failure

 

 

• · If ACE inhibitors or ARBs cannot be given:
• - Hydralazine
• - NitratesManagement of Unstable Angina (UA) / NSTEMI Anti-ischemic treatment. Read more ... »

 

NESIRITIDE

• Recombinant human brain or B type natriuretic pep­tide (BNP) :
• Improves dyspnoea CausesARKA Calotropis procera Ayurvedic Medicine for piles and Anal Fistula. Read more ... » vasodilatation Improves symptoms
• Hypotension may occur Clinical trials limited.
• Calcium sensitizer Prevents organ failure Improves symptoms Under trial.

 

ANTI-THROMBOTIC AGENTSCOMPLETE MANAGEMENT OF AMI Coronary Care Unit (CCU). Read more ... » in Heart Failure

• · In CHF (congestive heart failure) with AF (atrial fibrillation), thromboembolic events, LV throm­bus, LA thrombus – antithrombotic agents strongly recommended
• After MI – Aspirin recommended
• Aspirin avoided in severe heart failure
• · AnticoagulantDeep Vein Thrombosis Embolizations Antiplatelet Anticoagulant Treatment Therapy. Read more ... » avoided in patients who cannot be monitored
• · In pure heart failure there is no beneficial effect.

 

ANTIARRHYTHMICS

• · Class I avoided (quinidine,procainamide)
• · Beta blockers recommended
• Amiodarone is given for AF (atrial fibnrillation)
• Amiodarone also given for ventricular
• arrhythmias
• · Amiodarone not used in pure heart failure.

 

OXYGEN THERAPY in Heart Failure

• • No special indication

 

SURGERY AND DEVICES in Heart Failure

• · Revascularization
• · Cardiomyoplasty
• · Batista procedure (repair of myocardium).
• · Mitral and aortic valve surgery if required
• · LV aneurysmectomy for ventricular aneurysm
• · Stem cell therapy

 

Pacemakers:

• Cardiac Resynchronization Therapy:
• CRT (Cardiac resynchronization therapy) Biventricular pacing in :
• Ventricular dyssynchrony QRS> 120 ms
• NYHA III – IV
• Severe symptoms

 

ICD (Implantable cardioverter defibrillator)

• · Indication for ICD is VTVentricular Tachycardia VT Diagnosis Causes Clinical features with Treatment. Read more ... »(ventricular tachycardiaVentricular Tachycardia VT Diagnosis Causes Clinical features with Treatment. Read more ... ») or VF(ventricular fibrillationSupraventricular tachycardia and Ventricular fibrillation Causes Diagnosis with Treatment. Read more ... »)
• · For NYHA class III – IV and LVEF <30%
• · ICD with CRT (cardiac resynchronization therapy) is the treament for severe heart failure

 

Heart transplant Indications :

• · For end-stage heart failure
• · For severe symptoms
• · If all therapy failed
• · If facilities available
• ·Donor heart needed. Contraindications :
• · Infection
• · Renal failure
• · Cancer
• · Pulmonary disease
• · ThromboembolismCOMPLICATIONS OF Acute Myocardial Infarction (AMI) AND TREATMENT -2. Read more ... »
• · Alcohol or drugARKA Calotropis procera Ayurvedic Medicine for piles and Anal Fistula. Read more ... » abuse
• · Multiorgan disease.

 

Ventricular assist devices and Artificial heart

• · Useful for patients waiting for transplant
• · AcuteARKA Calotropis procera Ayurvedic Medicine for piles and Anal Fistula. Read more ... » myocarditisMYOCARDITIS Physical Examination Symptoms Clinical Manifestations Diagnosis. Read more ... »
• · For temporary hemodynamic support
• · Not for long term use
• · Not cost effective.

 

Ultrafiltration

• · For fluid overload refractory to diuretics
• · For severe heart failure
• · Temporary relief only.

 

Intraaortic balloon pumps used for

• · Severe heart failure
• · Cardiogenic shockShock Presentation Risk Factors Pathogenesis Management Treatment. Read more ... ».

 

Causes of refractory heart failure also called Worsening heart failure

• · Non compliance -Salt, Fluids, Lifestyle
• · Use of NSAIDs, Verapamil, Diltiazem
• · Infections
• · Alcohol and smoking
• · Renal failure
• · Pulmonary infarction
• · Anaemia
• , Heart block
• · MI (myocardial infarction)
• · Uncontrolled hypertensionChronic Long-term Complications Of Diabetes Mellitus. Read more ... »
• · ThyroidACTH and TSH DEFICIENCY Diagnosis with Treatment. Read more ... » disease
• · Severe MR (Mitral regurgitation), TR (Tricuspid regurgitationTricuspid Stenosis and Tricuspid Regurgitation Symptoms Investigations and Treatment. Read more ... »).
• · Atrial fibrillation
• · SVT (supra ventricular tachycardia)
• · VT (Ventricular tachycardia)
• · Bradycardia