Heart Failure - Treatment

Question 1

Approach to Heart Failure Treatment

Answer 1

1. Fluid Assessment
2. Disease Modification
3. Risk Reduction

Question 2

Non-Pharm

Answer 2

Sodium Restriction

Fluid Restriction

Exercise

Avoid alcohol
Quit smoking

Vaccinations to prevent pulmonary viruses

Question 3

Heart Failure
- Daily Weight Trackers

Answer 3

For patients that are more prone to fluid retention or can not control fluid retention

Question 4

Heart Failure
- Fluid Retention

Answer 4

Symptoms
+
2 lbs in 24 hours or 5 lbs in one week

Question 5

Symptoms of Fluid Retention

Answer 5

• Edema
• Weight Gain
• Shortness of breath
• Fatigue
• Reduced urine

Question 6

Decongestion Treatment

Answer 6

Diuretics

Question 7

Diuretic
- Mechanism

Answer 7

1. Inhibit sodium and water retention
2. Decrease preload volume
3. Decrease Pulmonary and Peripheral edema

Question 8

Diuretic
- Use

Answer 8

Rapid symptomatic relief of fluid retention
- Meant to reverse Volume Overload
- Does not prolong survival time or change disease progression

Question 9

Diuretic
- Drugs

Answer 9

Furosemide

Thiazide (Metolazone)
- Sometimes used along with Furosemide for diuretic resistance

Acetazolamide
- May be used in acute setting

Question 10

Diuretic
- Dosing

Answer 10

In acute heart failure
- Dose response curve shifts right and down
- Meaning more dose is needed to achieve an effect

Higher serum creatinine means a higher dose is needed

Question 11

Why does acute heart failure effect diuretic dosing

Answer 11

Renal perfusion, furosemide is not able to reach the kidney

Gut edema. extra fluid leaks into the gut so furosemide is not absorbed

Question 12

What affects dosing of diuretics

Answer 12

If you need fast diuresis = Higher dose

Older age = Lower dose

Inpatient vs Outpatient can determine how aggressive we want to treat

Baseline BP (Diuretic can drop it)

Baseline SCr (Higher dose is needed for high SCr to allow drug to reach kidney)

Question 13

Furosemide and Metolazone

Answer 13

Timing does not matter

Question 14

Diuretic
- Monitoring

Answer 14

Symptom improvement in 1-2 hours (Dependent on degree of fluid retention)
- Ex. Pedal Edema takes longer to resolve

Question 15

Symptoms of Hypervolemia vs Hypovolemia

Answer 15

Hypervolemia:
- Dyspnea
- Orthopnea
- PND

Hypovolemia
- Lightheadedness
- Reduced urine
- Thirst

Question 16

Diuretics
- Impact on electrolytes

Answer 16

Thiazide
- Increase calcium

Furosemide
- Decrease calcium

Both
- Decrease K, Mg, Na

Question 17

HFrEF Treatment

Answer 17

ACEi / ARB / ARNI

Beta Blockers

SGLT2i

MRA