Lang Lecture: HF Management

Lang Lecture: HF Management

1. Symptoms

   • Shortness of breath
   • Tiredness
   • Fluid retention
   • Weight change
   • Classification
     • Class I
       • No limitation
     • Class II
       • Slight limitation of physical activity
     • Class III
       • Marked limitation of physical activity
     • Class IV
       • Unable to perform physical activity without discomfort
   • Not all HF patients show symptoms

2. Diagnosis

   • ECG, Chest X-ray, echocardiogram
     • Echocardiogram is gold standard
       • Not widely available
   • BNP
     • Ventricular hormone
       • If BNP is a certain level HF ruled out
         • Males = 100 pg/ml Females = 150 pg/ml
           • High levels of BP indicate HF

3. Treatment

   • Lifestyle changes
     • Exercise
   • Pharmacologic
     • Diuretics
       • Control symptoms secondary to fluid retention
       • Higher dose associated with favourable trends
         • Lowered K+ and Mg+ associated with Sudden Death?
           • Lowered Na+
             • Stimulation of neurohormonal activity
     • ACE inhibitors
       • Increased Vasoconstriction
         • Increased Aldosterone
       • Improves symptoms
         • Reduced remodelling
           • Reduced hospitalization
             • Adverse effects
               • Worsening renal function
               • Cough
               • Hyperkalemia
               • Rash
     • Beta-blockers
       • Increased density of B receptors
         • Decreases HR
           • Antiarrhythmic
             • Antiischemic
               • Decreased Neurohormonal activation
         • Improves symptoms long term
           • Reduced remodelling
             • Reduced hospitalization
               • Reduce sudden death
                 • Adverse effects
                   • Hypotension
                   • Fluid retention
                   • Fatigue
                   • Bradycardia

4. Other Pharmacologic

   • Digitalis
     • When no adequate response to ACE-i, diuretics, beta-blockers
       • Slows AV conduction
         • Inhibits Na+/K+ ATPase. Increases intracellular sodium concn
   • Spironolactone
     • When no response to other drugs + late stage HF
       • Angiotensin receptor II blocker
         • Blocks vasoconstriction