Congestive heart failure pharmacotherapy: Difference between revisions
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{| style="border: 2px solid #4479BA; align="left" | |||
! style="width: 200px; background: #4479BA;" | {{fontcolor|#FFF|Sacubitril/Valsartan}} | |||
! style="width: 300px; background: #4479BA;" | {{fontcolor|#FFF| Ivabradine}} | |||
! style="width: 400px; background: #4479BA;" | {{fontcolor|#FFF|SGLT2 Inhibitors}} | |||
|- | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''Contraindications''' | |||
*Within 36 hours of [[ACEI]] use | |||
*History of [[angioedema]] with or without an [[ACEI]] or [[ARB]] | |||
*[[Pregnancy]] | |||
*[[Lactation]] (no data) | |||
*Severe [[hepatic]] impairment (Child-Pugh C) | |||
*Concomitant [[aliskiren]] use in patients with [[diabetes]] | |||
*Known [[hypersensitivity]] to either [[ARBs]] or [[ARNIs]] | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''Contraindications''' | |||
*[[HFpEF]] | |||
*Presence of [[angina]] with normal [[EF]] | |||
*[[Hypersensitivity]] | |||
*Severe [[hepatic]] impairment (Child-Pugh C) | |||
*Acute [[decompensated HF]] | |||
*[[Blood pressure]] <90/50 mm Hg | |||
*[[Sick sinus syndrome]] without a [[pacemaker]] | |||
*[[Sinoatrial node block]] | |||
*2nd or 3rd degree block without a [[pacemaker]] | |||
*Resting [[heart rate]] <60 beats/min | |||
*Persistent [[AF]] or [[atrial flutter]] | |||
*[[Atrial]] [[pacemaker]] dependence | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''Contraindications''' | |||
*Not approved for use in [[patients]] with type I [[diabetes]] due to increased risk of [[diabetic ketoacidosis]] | |||
*Known [[hypersensitivity]] to [[drug]] | |||
*[[Lactation]] (no data) | |||
*On [[dialysis]] | |||
|- | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''Causions''' | |||
*[[Renal]] impairment: | |||
*:Mild-to-moderate ([[eGFR]] 30-59 mL/ min/1.73 m2): no starting dose adjustment required | |||
*Severe ([[eGFR]] <30 mL/min/ 1.73 m2): | |||
*: Reduce starting dose to 24/26 mg twice daily, | |||
*: Double the dose every 2–4 weeks to target maintenance dose of 97/103 mg twice daily, as tolerated | |||
*[[Hepatic]] impairment: | |||
*:Mild (Child-Pugh A): no starting dose adjustment required | |||
*:Moderate (Child-Pugh B): | |||
*:Reduce starting dose to 24/26 mg twice daily | |||
*:Double the dose every 2–4 weeks to target maintenance dose of 97/103 mg twice daily, as tolerated | |||
*[[Renal artery stenosis]] | |||
*[[Systolic blood pressure]] <100 mm Hg | |||
*[[Volume]] depletion | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''Causions''' | |||
*[[Sinus node disease]] | |||
*[[Cardiac conduction]] defects | |||
*Prolonged [[QT interval]] | |||
| style="padding: 0 5px; background: #F5F5F5; text-align: left;" | '''Causions''' | |||
*For [[HF]] care, [[dapagliflozin]] in [[eGFR]] <30 mL/min/1.73 m2 | |||
*For [[HF]] care, [[empagliflozin]], in [[eGFR]] <20 mL/min/1.73 m2 | |||
*Pregnancy | |||
*Increased risk of [[mycotic genital infections]] | |||
*May contribute to [[volume depletion]], altering [[diuretic]] dose if applicable | |||
For prevention of [[ketoacidosis]] in [[patients]] with [[diabetes]]: | |||
*: Temporary discontinuation before scheduled [[surgery]] | |||
*Assess [[patients]] who present with signs and symptoms of [[metabolic acidosis]] for [[ketoacidosis]], regardless of [[blood glucose]] level | |||
*: For prevention of [[acute kidney injury]] and [[renal]] impairment: temporarily discontinuing in settings of reduced [[oral]] intake or [[fluid losses]] | |||
*[[Urosepsis]] and [[pyelonephritis]]: evaluation for [[signs]] and [[symptoms]] of [[urinary tract infections]] and treatment | |||
*[[Necrotizing fasciitis]] of the [[perineum]] ([[Fournier’s gangrene]]): rare, serious, life-threatening cases, assessment of [[pain]] or [[tenderness]], | |||
[[erythema]], or [[swelling]] in the [[genital ]] or [[perineal]] area, along with [[fever]] or [[malaise]] | |||
|- | |||
|} | |||
{{clear}} | |||
Revision as of 03:55, 15 December 2021
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
The following table summarized the stepwise treatment for heart failure.
Congestive heart failure treatment summary based on 2021 ACC/AHA Guideline
Pathophysiology | Treatment |
---|---|
Renin-angiotensin-aldosterone system | ARNIs/ACEIs/ARBs, aldosterone
antagonist |
Sympathetic nervous system | Beta-blockers |
Natriuretic and other vasodilator peptides | Neprilysin inhibitor (ARNI) |
Sodium-glucose cotransporter-2 | SGLT2 inhibitors |
Balanced vasodilation and oxidative stress modulation | Hydralazine/Isosorbide dinitrate |
Elevated heart rate | Betablocker, Ivabradine |
Guanylyl cyclase | Soluble guanylyl cyclase stimulator |
Relief of congestion | Diuretic |
Ventricul;ar arrhythmia | Implantable cardioverter defibrilator |
Ventricular dyssynchrony due to conduction abnormalities | Cardiac resynchronization therapy |
Mitral regurgitation | Surgical or percutaneous Mitral repair |
Reduced aerobic capacity | Aerobic exercise training |
Sacubitril/Valsartan | Ivabradine | SGLT2 Inhibitors |
---|---|---|
Contraindications | Contraindications
|
Contraindications
|
Causions
|
Causions
|
Causions
For prevention of ketoacidosis in patients with diabetes:
erythema, or swelling in the genital or perineal area, along with fever or malaise |
Acute Decompensated | Chronic | |
---|---|---|
HFpEF | ||
HFrEF |
|