HFrEF exacerbation (Assessment and Plan): Difference between revisions
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Author: [[User:William J Gibson|William J Gibson MD, PhD]] | |||
Dx: | Dx: | ||
- tele; strict I/O; cardiac diet (2L fluid, 2g Na); daily weights | |||
- BID BMP/Mg | |||
- TTE | |||
Tx: | Tx: | ||
Contractility: | |||
Preload: IV lasix BID or PO torsemide BID or Bumex drip (0-2 mg/hr). If diuresis inadequate with these agents can give metolazone 30 min before loop diuretic. | |||
Afterload: captopril Q8H (titrate quickly and then convert to lisinopril), or . ACE first line as mortality benefit in all. Isordil/hydralazine has mortality benefit in blacks. | |||
Neurohormonal blockade: Continue home [spironolactone/eplerenone]. Spironolactone and eplerenone inhibit aldosterone and decrease mortality in randomized trials (RALES trial; EMPHASIS-HF trial). Hold if AKI. | |||
References: | References: | ||
Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186-92. | Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186-92. | ||
Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341(10):709-17. | |||
Zannad F, Mcmurray JJ, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364(1):11-21. | RALES trial: Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341(10):709-17. | ||
EMPHASIS-HF trial: Zannad F, Mcmurray JJ, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364(1):11-21. | |||
Revision as of 23:47, 11 November 2017
Author: William J Gibson MD, PhD
Dx:
- tele; strict I/O; cardiac diet (2L fluid, 2g Na); daily weights
- BID BMP/Mg
- TTE
Tx:
Contractility:
Preload: IV lasix BID or PO torsemide BID or Bumex drip (0-2 mg/hr). If diuresis inadequate with these agents can give metolazone 30 min before loop diuretic.
Afterload: captopril Q8H (titrate quickly and then convert to lisinopril), or . ACE first line as mortality benefit in all. Isordil/hydralazine has mortality benefit in blacks.
Neurohormonal blockade: Continue home [spironolactone/eplerenone]. Spironolactone and eplerenone inhibit aldosterone and decrease mortality in randomized trials (RALES trial; EMPHASIS-HF trial). Hold if AKI.
References:
Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186-92.
RALES trial: Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341(10):709-17.
EMPHASIS-HF trial: Zannad F, Mcmurray JJ, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364(1):11-21.