Congestive heart failure chronic pharmacotherapy: Difference between revisions

	Congestive Heart Failure Microchapters
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Pathophysiology Systolic Dysfunction Diastolic Dysfunction HFpEF HFrEF
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Differentiating Congestive heart failure from other Diseases
Epidemiology and Demographics
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Natural History, Complications and Prognosis
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Treatment
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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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Revision as of 22:34, 11 November 2012

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

Improvement of the symptoms
Decreased morbidity and mortality

The Management Plan

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^[1].
Decrease mortality and morbidity by the use of ACE inhibitors and beta blockers^[2]
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
- Diabetes and hyperthyroidism^[3].
Low salt diet^[4]
Weight management to check for fluid overload
Vaccines for influenza and pneumococcus^[5].

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

References

↑ Michael Felker G (2010). "Diuretic management in heart failure". Congest Heart Fail. 16 Suppl 1: S68–72. doi:10.1111/j.1751-7133.2010.00172.x. PMID 20653715.
↑ Shiokawa Y (1975). "Proceedings: Streptococcus surveys in Ryukyu Islands, Japan". Jpn Circ J. 39 (2): 168–71. PMID 1117548.
↑ DeGroot WJ, Leonard JJ (1970). "Hyperthyroidism as a high cardiac output state". Am Heart J. 79 (2): 265–75. PMID 4903771.
↑ Evangelista LS, Shinnick MA (2008). "What do we know about adherence and self-care?". J Cardiovasc Nurs. 23 (3): 250–7. doi:10.1097/01.JCN.0000317428.98844.4d. PMC 2880251. PMID 18437067.CS1 maint: PMC format (link)
↑ Martins Wde A, Ribeiro MD, Oliveira LB, Barros Lda S, Jorge AC, Santos CM; et al. (2011). "Influenza and pneumococcal vaccination in heart failure: a little applied recommendation". Arq Bras Cardiol. 96 (3): 240–5. PMID 21271169.

[pmid20653715-1] Michael Felker G (2010). "Diuretic management in heart failure". Congest Heart Fail. 16 Suppl 1: S68–72. doi:10.1111/j.1751-7133.2010.00172.x. PMID 20653715.

[pmid1117548-2] Shiokawa Y (1975). "Proceedings: Streptococcus surveys in Ryukyu Islands, Japan". Jpn Circ J. 39 (2): 168–71. PMID 1117548.

[pmid4903771-3] DeGroot WJ, Leonard JJ (1970). "Hyperthyroidism as a high cardiac output state". Am Heart J. 79 (2): 265–75. PMID 4903771.

[pmid18437067-4] Evangelista LS, Shinnick MA (2008). "What do we know about adherence and self-care?". J Cardiovasc Nurs. 23 (3): 250–7. doi:10.1097/01.JCN.0000317428.98844.4d. PMC 2880251. PMID 18437067.CS1 maint: PMC format (link)

[pmid21271169-5] Martins Wde A, Ribeiro MD, Oliveira LB, Barros Lda S, Jorge AC, Santos CM; et al. (2011). "Influenza and pneumococcal vaccination in heart failure: a little applied recommendation". Arq Bras Cardiol. 96 (3): 240–5. PMID 21271169.

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@@ Line 7: / Line 7: @@
 ==Chronic Pharmacotherapy==
-The goals of the treatment of [[heart failure]] are:
+===The goals of the Treatment of Heart Failure===
 * Improvement of the symptoms
 * Decreased morbidity and mortality
-The management of chronic [[heart failure]] includes:
+===The Management Plan===
 * 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<ref name="pmid20653715">{{cite journal| author=Michael Felker G| title=Diuretic management in heart failure. | journal=Congest Heart Fail | year= 2010 | volume= 16 Suppl 1 | issue=  | pages= S68-72 | pmid=20653715 | doi=10.1111/j.1751-7133.2010.00172.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20653715  }} </ref>.