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MANAGEMENT

MAIN GOALS OF THERAPY :


Identification and correction of the underlying
conditions
Elimination of the acute precipitating cause of
symptoms.
Treatment of the acute symptoms of
congestive heart failure
Improvement in longterm survival.

STAGES OF HEART
FAILURE
- STAGE A :
Px at risk developing HF co morbid
condition.
No sympt and sign.
No structural & functional abnormality.
ex: HTN, CAD, DM
- STAGE B :
structural HD strongly assc HF.
no sympt and sign. Ec LVH, valvular heart
disease, previous MI

Stage of HF cont..
Stage C :

Px who have current or prior symptom of HF


assc with underlying structural HD.
Stage D :

Px with marked symptom of HF at rest


despite max medical therapy and who
required intervention.

At high risk for HF but


without structural
Stage A
heart disease or
symptoms of HF
Patients with:
Hypertension
Atherosclerotic
Disease
DM
Obesity
Metabolic Syndrome
OR
Using cardiotoxins
With family history
of cardiomyopathy
Structural
Heart
Disease

Goals:
Heart healthy lifestyle
Prevent vascular,
coronary disease
Prevent LV structural
abnormalities
Drugs:
ACEI or ARB in
appropriate patients for
vascular disease
Statins as appropriate

Stage B

Structural heart
disease but without
signs or symptoms
of HF

Patients with:
Previous MI
LV remodeling including
LVH and low EF
Asymptomatic valvular
disease

Developme
nt of
symptoms
of HF

Goals:
Prevent HF
symptoms
Prevent further
cardiac remodeling
Drugs:
ACEI or ARB as
appropriate
Beta blockers as
appropriate
In selected
patients:
ICD
Revascularization
or valvular surgery
as appropriate

HF
Preserved
EF

Goals:
Control symptoms
Improve HRQOL
Prevent hospitalization
Prevent Mortality
Strategies:
Identification of
comorbidities
Treatment:
Diuresis to relieve
symptoms of congestion
Follow guideline driven
indications for
comorbidities, e.g.,
HTN, AF, CAD, DM

HF
Reduced
EF
Goals:
Control symptoms
Patient education
Prevent hospitalization
Prevent Mortality
Drugs for routine use:
Diuretics for fluid
retention
ACEI or ARB
Beta blockers
Aldosterone
antagonists
Drugs for use in selected
patients:
Hydralazine/ISDN
ACEI and ARB
Digitalis
In selected patients:
CRT
ICD
Revascularization or
valvular surgery as
appropriate

- Diuretics
Diuretics patients fluid retention, unless
contraindicated, to improve symptoms.
- ACE Inhibitor
ACE inhibitors patients current or prior
symptoms, unless contraindicated, to reduce
morbidity and mortality
-Beta Blocker
Use of 1 of the 3 beta blockers proven to reduce
mortality (e.g., bisoprolol, carvedilol, and sustainedrelease metoprolol succinate)
- Angiotensin Receptor Blocker (ARB)
-Aldosterone receptor antagonists
-ISOSORBIDE DINITRATE
-DIGOXIN

Stage D

Refractory
HF

e.g., Patients with:


Marked HF symptoms
at
rest
Recurrent
hospitalizations
despite GDMT

Goals
Control symptoms
Improve HRQOL
Reduce hospital
readmissions
Establish patients end
of-life goals
Options
Advanced care
measures
Heart transplant
Chronic inotropes
Temporary or permanent
MCS
Experimental surgery or
drugs
Palliative care and
hospice
ICD deactivation