Cardiology overview heart failure: Difference between revisions
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==Mechanical Therapy== | ==Mechanical Therapy== | ||
* Cardiac resynchronization therapy has been associated with improvement in symptoms and a reduction in hospitalizations. | * Cardiac resynchronization therapy has been associated with improvement in symptoms and a reduction in hospitalizations. | ||
* Cardiac recent organization therapy should only be undertaken if the blood pressure is low and if the heart failure medicines have been optimized | |||
==Ultrafiltration== | ==Ultrafiltration== | ||
Revision as of 18:48, 31 October 2011
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Cardiology Overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Pharmacotherapy
Angiotensin Converting Enzyme (ACE) Inhibition
- Improve LV remodeling following ST elevation MI
- Even in patients who are asymptomatic with LV dysfunction, this class improves the odds of developing symptoms and survival.
Lasix
- Higher lasix doses are associated with higher mortality, likely as a surrogate of disease severity rather than part of a causal pathway.
Digoxin
- Digoxin has not been associated with improvement in survival. It has been associated with a reduction in rehospitalization. In the DIG trial, the most effective and safest levels of digoxin were levels less than 1 ng/mL. levels greater than 1 ng/ml were no more effective and were associated with a trend towards higher mortality.
Beta Blockers
Lopressor should be used instead of atenolol in the patient with CHF
Metformin
Enoxaparin and Antiocagulation
- While hospitalized, patients with CHF should receive DVT prophylaxis
Drugs to Avoid in CHF
- Dronedarone should be avoided in patients who were hospitalized with CHF (this is a boxed warning)
- Sotalol (has a negative inotropic effect)
Mechanical Therapy
- Cardiac resynchronization therapy has been associated with improvement in symptoms and a reduction in hospitalizations.
- Cardiac recent organization therapy should only be undertaken if the blood pressure is low and if the heart failure medicines have been optimized
Ultrafiltration
- Ultrafiltration has been associated with a reduced incidence of hospitalization compared with diuretics in the UNLOAD trial. There was no difference in mortality.
Invasive Monitoring
- Based upon the results of the ESCAPE trial, there is no benefit in clinical outcomes with the use of a pulmonary artery line in patients with decompensated CHF.
Obstructive Sleep Apnea in the Patient with CHF
- Central sleep apnea in the patient with CHF is due to the compensatory respiratory alkalosis that is present in the patient with CHF and tachypnea