Decompensated Heart Failure Workup

Medicines that lead to fluid retention can be dangerous, including corticosteroids and NSAIDs such as selective COX-2 inhibitors. Medicines with negative inotropic effects (verapamil and diltiazem) may also precipitate heart failure symptoms.

Thiazolidinediones used in the management of type 2 diabetes may worsen heart failure. Rosiglitazone is contraindicated for patients with a history of heart failure, but pioglitazone can be used with caution by patients with New York Heart Association class I heart failure.

HFrEF

• Investigations

  • ECG
    • [ ] https://litfl.com/dilated-cardiomyopathy-dcm-ecg-library/

• Management

  • Non-pharmacological interventions

    • Heart failure management program
      • 12 week multidisciplinary hear failure program → educates patients and their carers about self management of heart failure
    • Salt restriction <2g of sodium per day
    • Fluid restriction <2L per day
    • Physical activity
    • Daily weight → early detection and adjustment of diuretic dose to prevent hospital admission
    • Weight loss in overweight or obese patients
    • Smoking cessation

  • Pharmacological

    • Heart foundation guidelines

    

• Beta blockers

  • 🍒The four beta-blockers with evidence for use in congestive cardiac failure in terms of providing a mortality benefit are ****nebivolol, carvedilol, bisoprolol, and metoprolol

HFpEF