Heart Failure Management Quiz

Management of Heart Failure

• General Management:

  • Bed rest in a propped-up position (left-hand side or right-hand side, as needed)
  • Supplemental oxygen as needed
  • Patient education regarding the disease, treatment, and self-care strategies
  • Daily monitoring of weight to adjust diuretic medications
  • Moderate aerobic exercise, limited by symptoms
  • Healthy diet, avoiding high salt, smoking, and excessive alcohol consumption
  • Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided

• Specific Therapy:

  • ACE Inhibitors: Preferred over vasodilators, such as captopril, enalapril, lisinopril, remifentanil, and trandolapril
  • Angiotensin Receptor Blockers (ARBs): Used if patients cannot tolerate ACE inhibitors, such as losartan, candesartan, and valsartan
  • Beta-blockers: Bisoprolol, metoprolol CR/XL, carvedilol, nebivolol
  • Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors: Dapagliflozin, empagliflozin, sotagliflozin
  • Angiotensin Receptor-Neprilysin Inhibitors (ARNIs): Sacubitril/valsartan (trade name Entresto)
  • Ivabradine: For patients with normal sinus rhythm; when heart rate is too high, this can be a treatment option
  • Diuretics:
    • Hydrochlorothiazide (50-100mg/day)
    • Furosemide, used for fluid overload
    • Potassium-sparing diuretics (spironolactone or eplerenone)

• Vasodilators:

  • Organic nitrates (venodilators)
  • Arterial dilators (hydrazoline)

• Treatment of Complications:

  • Digoxin for atrial fibrillation
  • Amiodarone for arrhythmias
  • Anticoagulants for atrial fibrillation, previous thromboembolic events, or cardiac clots seen on an echocardiogram

• Avoidance and Treatment of Underlying Causes:

  • Treat Infections
  • Influenza and pneumococcal vaccinations
  • Aggressive management of hypertension
  • Diabetes management
  • Anemia correction
  • Valve repair or replacement, if needed, for valvular heart disease (VHD)
  • Coronary artery bypass graft (CABG) procedure for ischemic heart disease (IHD)

• Cardiac Rehabilitation:

  • Regular stamina-building exercises (brisk walking, swimming)

• Procedural Interventions:

  • Cardiac resynchronization therapy (CRT) with biventricular pacing