Sandbox Rim: Difference between revisions
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{{Family tree/start}} | {{Family tree/start}} | ||
{{Family tree | {{Family tree | | | | | | | A01 | | | | | | | | | | A01= '''What is the stage of heart failure (HF)?'''}} | ||
{{Family tree | |,|-|-|-|v|-|-|- | {{Family tree | |,|-|-|-|v|-|^|-|-|-|v|-|-|-|-|.| }} | ||
{{Family tree | B01 | | B02 | | B03 | | | {{Family tree | B01 | | B02 | | | | B03 | | | | B04 | | B01= '''Stage A''' <br>''At high risk for HF but without structural heart disease or symptoms of HF''| B02= '''Stage B''' <br> ''Structural heart disease but without signs or symptoms of HF''| B03= '''Stage C '''<br>''Structural heart disease with prior or current symptoms of HF''| B04= '''Stage D''' <br> ''Refractory HF requiring specialized interventions'' }} | ||
{{Family tree | |!| | | |!| | | | | {{Family tree | |!| | | |!| | | | | |!| | | | | |!| | | }} | ||
{{Family tree | C01 | | C02 | | C03 | | | {{Family tree | C01 | | C02 | | | | C03 | | | | C04 | | C01= | ||
* Encourage healthy lifestyle and exercise | * Encourage healthy lifestyle and exercise | ||
* Treat hypertension ( I-A) | * Treat hypertension ( I-A) | ||
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* Consider ICD placement to prevent sudden death if asymptomatic ischemic cardiomyopathy, > 40 days post-MI, LVEF <= 30%, on adequate medical therapy, and good 1 year survival | * Consider ICD placement to prevent sudden death if asymptomatic ischemic cardiomyopathy, > 40 days post-MI, LVEF <= 30%, on adequate medical therapy, and good 1 year survival | ||
| C03= | | C03= | ||
''Non-medical therapy in all patients:'' | |||
* Exercise training (I-A) | |||
* Education for self-care (I-B) | |||
* Sodium restriction if symptomatic (IIa-C) | |||
* Cardiac rehabilitation in patients clinically stable (IIa-B) | |||
* Treatment of HTN, dyslipidemia, obesity, DM | |||
* Avoid tobacco (I-C) | |||
* Avoid cardiotoxic agents | |||
| C04= | | C04= | ||
'''''Fluid restriction:''''' | |||
Restriction to 1.5 to 2 L/d particularly in case of hyponatremia (IIa-C) | |||
'''''Inotropes''''' | |||
* Temporary inotropes: Cardiogenic shock to maintain perfusion, awaiting definitive therapy or resolution of acute precipitating event (I-C) | |||
* Continuous inotropes: | |||
:* Bridge therapy in stage D HF refractory to medical therapy and device therapy among patients eligible/awaiting MCS or heart transplant (IIa-B) | |||
:* Short-term, continuous intravenous inotropes to maintain perfusion among hospitalized, severe systolic dysfunction, low blood pressure and significantly decreased cardiac output (IIb-B) | |||
:* Long-term, continuous intravenous inotropes for symptom control in select patients with stage D HF despite optimal GDMT and device therapy who are not eligible for either MCS or cardiac transplantation (IIb-B) | |||
'''''Mechanical circulatory support (MCS)''''' | |||
* Temporary MCS in HFrEF awaiting definitive therapy or resolution of acute precipitating event (I-B) | |||
* Temporary MCS HFrEF with severe hemodynamic compromise, as a bridge therapy to recovery or decision (I-B) | |||
* Durable MCS to prolong survival in selected patients (LVEF <25% and NYHA class III–IV functional status despite GDMT, including, when indicated, CRT, with either high predicted 1- to 2-year mortality, or dependence on continuous parenteral inotropic support, Multidisciplinary team) (I-B) | |||
'''''Cardiac transplantation''''' | |||
* Refractory to medical therapy, device, and surgery (I-C)}} | |||
{{Family tree/end}} | {{Family tree/end}} | ||
What is the ejection fraction? | |||
B03= '''Stage C HFrEF'''<br>''Structural heart disease with prior or current symptoms of HF and reduced ejection fraction''| B04= '''Stage C HFpEF''' <br> ''Structural heart disease with prior or current symptoms of HF and preserved ejection fraction''} |
Revision as of 19:42, 12 March 2015
Treatment of Acute Decompensation of Heart Failure
Initial stabilization: Assess congestion and perfusion: Admit for in-hospital treatment if: Identify precipitating factor and treat accordingly:
❑ COPD Treat congestion and optimize volume status: Venodilators Treat low perfusion: VTE prevention: Chronic medical therapy: Management of hyponatremia: | |||||||||
Chronic Treatment for Heart Failure
What is the stage of heart failure (HF)? | |||||||||||||||||||||||||||||||||||||||||
Stage A At high risk for HF but without structural heart disease or symptoms of HF | Stage B Structural heart disease but without signs or symptoms of HF | Stage C Structural heart disease with prior or current symptoms of HF | Stage D Refractory HF requiring specialized interventions | ||||||||||||||||||||||||||||||||||||||
* Encourage healthy lifestyle and exercise
| * Encourage healthy lifestyle and exercise
Additional measures in selected patients:
| Non-medical therapy in all patients:
| Fluid restriction:
Restriction to 1.5 to 2 L/d particularly in case of hyponatremia (IIa-C) Inotropes
Mechanical circulatory support (MCS)
Cardiac transplantation
| ||||||||||||||||||||||||||||||||||||||
What is the ejection fraction?
B03= Stage C HFrEF
Structural heart disease with prior or current symptoms of HF and reduced ejection fraction| B04= Stage C HFpEF
Structural heart disease with prior or current symptoms of HF and preserved ejection fraction}