chronic heart failure
| Impaired diastolic or systolic function (by definition!) | |
|---|---|
| Etiology | Secondary to hypertension, ischaemic heart disease, valvular disease, myocarditis. Less common: congenital heart disease, Rheumatoid arthritis, toxin-induced e.g. alcohol, cocaine. |
| Epidemiology | |
| Clinical presentation | Acute: pulmonary oedema; cardiogenic shock, chronic: decompensation (see acute); exertional SOB |
| Pathogenesis | |
| Diagnostic investigations | nt-pro BNP Echo |
| Management | - meds r/v; modifiable risk factors; screen for depression - loop diuretic if fluid overload present - ACE inhibitors, beta blockers - if still symptomatic, offer mineralocorticoid receptor antagonist - under specialist advice: - if EF <35%, replace ACE-i with sacubitril-valsartan - An SGLT-2 inhibitor (empagliflozin or dapagliflozin). - Ivabradine for people in sinus rhythm with a heart rate over 75 beats per minute (bpm) and ejection fraction less than 35%. - Hydralazine and nitrate (especially if of African-Caribbean descent). Annual flu vax + pneumococcal |
end stage heart failure
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