Congestive heart failure chronic pharmacotherapy

Congestive Heart Failure Microchapters
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Overview
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Classification
Pathophysiology Systolic Dysfunction Diastolic Dysfunction HFpEF HFrEF
Causes
Differentiating Congestive heart failure from other Diseases
Epidemiology and Demographics
Risk Factors
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Natural History, Complications and Prognosis
Diagnosis
Clinical Assessment
History and Symptoms
Physical Examination
Laboratory Findings
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Exercise Stress Test
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Treatment
Invasive Hemodynamic Monitoring
Medical Therapy:
Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF Diuretics ACE Inhibitors Angiotensin receptor blockers Aldosterone Antagonists Beta Blockers Ca Channel Blockers Nitrates Hydralazine Positive Inotropics Anticoagulants Angiotensin Receptor-Neprilysin Inhibitor Antiarrhythmic Drugs Nutritional Supplements Hormonal Therapies Drugs to Avoid Drug Interactions Treatment of underlying causes Associated conditions
Exercise Training
Surgical Therapy: Biventricular Pacing or Cardiac Resynchronization Therapy (CRT) Implantation of Intracardiac Defibrillator Ultrafiltration Cardiac Surgery Left Ventricular Assist Devices (LVADs) Cardiac Transplantation
ACC/AHA Guideline Recommendations Initial and Serial Evaluation of the HF Patient Hospitalized Patient Patients With a Prior MI Sudden Cardiac Death Prevention Surgical/Percutaneous/Transcather Interventional Treatments of HF Patients at high risk for developing heart failure (Stage A) Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B) Patients with current or prior symptoms of heart failure (Stage C) Patients with refractory end-stage heart failure (Stage D) Coordinating Care for Patients With Chronic HF Quality Metrics/Performance Measures
Implementation of Practice Guidelines
Congestive heart failure end-of-life considerations
Specific Groups: Special Populations Patients who have concomitant disorders Obstructive Sleep Apnea in the Patient with CHF NSTEMI with Heart Failure and Cardiogenic Shock
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Assistant editor-in-chief Rim Halaby

Overview

The chronic management of heart failure aims first to treat the symptoms of the patient and improve the exercise tolerance and quality of life. The use of diuretics and regular assessment of the patient's weight helps in avoiding excess body fluids that cause the symptoms of dyspnea and orthopnea. In addition, the treatment of heart failure also aims to decrease the rate of hospitalization and associated morbidity and mortality. Hence, all patients with heart failure should take ACE inhibitors (or ARB) and beta blockers. If the patient remained symptomatic, further management is advised.

Chronic Pharmacotherapy

The goals of the treatment of heart failure are:

• Improvement of the symptoms
• Decreased morbidity and mortality

The management of chronic heart failure includes:

• Improvement of the symptoms by the use of diuretics: In fact diuretics help in maintaining a normal fluid status and decrease pulmonary edema that causes dyspnea and orthopnea.
• Decrease mortality and morbidity by the use of ACE inhibitors and beta blockers
• Treatment of the underlying cause of heart failure: hypertension, ischemic heart disease, valve abnormalities.
• Treatment of other non cardiac diseases that might contribute to the symptoms of heart failure like diabetes and hyperthyroidism.
• Diet: Low salt
• Weight management to check for fluid overload
• Vaccines for influenza and pneumococcus.

Shown below is an image that summarizes the steps in the chronic management of patients with heart failure.

Management of chronic heart failure