Cardiology overview heart failure

Cardiology Overview
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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.

Beta Blockers

Lopressor should be used instead of atenolol in the patient with CHF

Metformin

• Metformin use in diabetics with CHF is associated with lower mortality

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.

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