HFrEF exacerbation (Assessment and Plan)

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Dx: Tx: 

Contractility: 

Preload: IV lasix BID.

Afterload: Continue home [lisinopril].

Neurohormonal blockade: Continue home [spironolactone/eplerenone]. Spironolactone and eplerenone inhibit aldosterone and decrease mortality in randomized trials (RALES - Pitt et al. NEJM 1999;EMPHASIS-HF - Zannad et al. NEJM 2011). Hold if AKI.

References: Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186-92. Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med. 1999;341(10):709-17. Zannad F, Mcmurray JJ, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364(1):11-21.

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