Treatment of heart failure

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Treatment of heart failure by Mind Map: Treatment of heart failure

1. Emergency?

1.1. RR>25 or accessory muscle use

1.2. PR>130 or <40

1.3. SBP<90 mmHg

1.4. O2 sat<90, on cannula or on tune

1.5. Poor perfusion

2. Supportive

2.1. Bed rest and semi fowler’s position

2.2. Oxygen therapy if O2sat<90%, PaO2<60mmHg

2.3. Morphine if agitate (!!!BP,RR)

2.4. Sodium and fluid restriction

3. Symptomatic treatment: acute HF

3.1. Initial therapy

3.1.1. Decreased Preload Diuretic Loop: furosemide, bumetanide, torsemide Thiazide Spironolactone !!Ultraflitration Vasodilator Nitroglycerine

3.1.2. Increased contractility (If decrease CO) Inotrope 1st: dobutamine: also vasodilator (s/e hypotension) 2nd: dopamine 3rd: milrinone (if Pt. on beta block)

3.1.3. Decreased Afterload Vasodilator Nitroprusside ACEI

3.2. แนวทางการจำแนกผู้ป่วย

3.2.1. 1. Congestion: wet or dry; 2. Perfusion: cold or warm Wet and cold Inotrope (If BP drop), vasodilator, diuretic Wet and warm (most common) Vasodilator, diuretic Dry and cold Inotrope or IV fluid Dry and warm Adjust drug

4. Specific treatment

4.1. Correction of underlying causes

4.1.1. Revascularization in CAD

4.1.2. Surgical replacement or percutaneous intervention in valvular heart disease

4.1.3. Pericardial drainage and pericardectomy

4.2. Removal of precipitating factors

4.2.1. Correct anemia

4.2.2. Hypertension -

4.2.3. Salt and water restriction

4.3. Improve myocardial function (only in HFrEF) แนะนำ beta block,ACEI ที่ 40, spinorolactone ที่ 35

4.3.1. Initial ACEI Effect Example: enalapril, captopril S/E chronic cough, hypotension, renal failure, hyperkalemia Contraindications ARB ACEI intolerance (no cough) S/E hypotension, renal failure, hyperkalemia Contraindications Example losartan, irbesartan Beta-blocker Example nebivolol, bisoprolol, carvedilol, metoprolol succinate No or minimal current evidence of fluid retantion (compensated HF) Effect Contraindications

4.3.2. Additional Mineralocorticoid antagonist (MRA) Example spinorolactone, eplerenone Recommend in post-STEMI Contraindications Angiotensin receptor-neprilysin inhibitor Ivabradine Pt. on max dose of beta block Decrease HR (if beta block failed ในการลด HR) ลด HR ได้ 10 Funny channel Digoxin