Section VIII: Heart Failure and Hypertension View Full Chapter Figures Only Tables Only Videos Only Print Share Email Twitter Facebook Linkedin Reddit Get Citation Citation AMA Citation Heart Failure and Hypertension. In: Higgins JP, Ali A, Filsoof DM. Higgins J.P., Ali A, Filsoof D.M. Eds. John P. Higgins, et al.eds. Cardiology Clinical Questions, 2e New York, NY: McGraw-Hill; . http://accesscardiology.mhmedical.com/content.aspx?bookid=1966§ionid=146416430. Accessed April 24, 2018. MLA Citation . "Heart Failure and Hypertension." Cardiology Clinical Questions, 2e Higgins JP, Ali A, Filsoof DM. Higgins J.P., Ali A, Filsoof D.M. Eds. John P. Higgins, et al. New York, NY: McGraw-Hill, , http://accesscardiology.mhmedical.com/content.aspx?bookid=1966§ionid=146416430. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager Mendeley © Copyright Tools Search Book Top Return Clip Autosuggest Results ++ How do I manage heart failure with reduced ejection fraction (HFrEF)? ++ Table Graphic Jump LocationFavorite Table | Download (.pdf) | Print The management of heart failure is based upon relieving symptoms of volume overload (congestion, dyspnea) and improving left ventricular function. HPI: Dyspnea on exertion or at rest, fatigue, weakness, diaphoresis, paroxysmal nocturnal dyspnea, orthopnea PMH: Ischemic heart disease Nonischemic causes: HTN, HIV, connective tissue disease, substance abuse, infiltrative disease, myocarditis, doxorubicin, arrhythmias (e.g., Afib), valvular disease (aortic stenosis, mitral stenosis, aortic insufficiency, mitral insufficiency). PSH: Smoking, alcohol. Elevated jugular venous pressure, rales, laterally displaced apical impulse, S3 gallop, peripheral edema. ECHO: LVEF <40%, LA and LV enlargement, wall motion abnormalities. X-ray: Cardiomegaly, cephalization of pulmonary vessels (increased distribution of flow to apices), pleural effusion. S-HF = Patient with Systolic Heart Failure, LVEF <40%. LVEF = Left Ventricular Ejection Fraction. AFIB = Atrial FIBrillation. FUROS = FUROSemide 40 mg IV load followed by 20 mg/hr. ACEI = ACE-Inhibitor enalapril 2.5 mg BID, captopril 6.25 mg TID, lisinppril 5–10 mg daily titrated to a maintenance dose. If patient unable to tolerate ACE inhibitors, give angiotensin II receptor blocker (ARB) valsartan orally 40 mg BID titrated to a maintenance dose of 80–160 mg BID. BB = Carvedilol 3.125 mg BID titrated to 25 mg BID or oral extended release metoprolol 25 mg QD upto 100 mg QID. DIG = DIGoxin 0.125 to 0.25 mg QD for 2 days followed by 0.25 od maintenance dose. HYD = HYDralazine 25–50 mg 3–4 times daily up to 300 mg in divided doses. NIT = Isosorbide diNITrate 20–30 mg 3–4 times a day. INTOL-ACEI = Patients who are INTOLerable to ACE Inhibitors or angiotensin II receptor blockers. INEFF = INEFFective treatment with furosemide and enalapril, with patient exhibiting symptoms of heart failure (dyspnea, weakness, elevated BP). S-HF = FUROS + ACEI + BB S-HF + INTOL-ACEI = FUROS + HYD + NIT + BB S-HF + INEFF = FUROS + ACEI (or HYD+NIT) + BB + DIG S-HF + AFIB = FUROS + ACEI + BB + DIG S-HF + AFIB + INTOL-ACEI = FUROS + HYD + NIT + BB + DIG Digoxin is effective in increasing cardiac output, improving exercise capacity and left ventricular function in patients with systolic heart failure unresponsive to diuretics, ACE inhibitors, and beta blockers. While neurohormonal effects occur with doses of digoxin <0.25 mg/day, positive inotropic actions usually require doses ≥0.25 mg/day. – DIG trial has shown digoxin therapy to significantly reduce hospitalization rates for patients with heart failure, but no benefits in overall mortality. – Furosemide and digoxin only provides symptomatic relief as opposed to aldactone which in addition to symptomatic relief, provides mortality benefit in patients with HFrEF. – Avoid ACE-I and ARBs – Start with loop diuretic in volume overloaded patients, ACE-I or ARB and then a BB. – Start low dose and then titrate to maintenance. – Check potassium levels with patients on ACE-I/ARB/furosemide/spironolactone 2 weeks ... GET ACCESS TO THIS RESOURCE Sign In Username or Email Please enter User Name Password Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. What is MyAccess? Create a FREE MyAccess profile to: Use this site remotely Bookmark your favorite content Track your self-assessment progress and more! GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessCardiology 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessCardiology Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options Pop-up div Successfully Displayed This div only appears when the trigger link is hovered over. Otherwise it is hidden from view. Please Wait