733
edits
Heart Failure: Difference between revisions
Jump to navigation
Jump to search
→Therapy of acute heart failure
| (12 intermediate revisions by the same user not shown) | |||
| Line 318: | Line 318: | ||
Deficiency of thiamine, selenium, or camitine, in states of severe cachexia. | Deficiency of thiamine, selenium, or camitine, in states of severe cachexia. | ||
Infiltrative and storage disorders | ===Infiltrative and storage disorders=== | ||
*[[Sarcoidosis]] | *[[Sarcoidosis]] | ||
*[[Amyloidosis]] | *[[Amyloidosis]] | ||
| Line 325: | Line 325: | ||
===Infectious disease=== | ===Infectious disease=== | ||
*Chagas’ disease | *[[Chagas’ disease]] | ||
*HIV infection | *[[HIV infection]] | ||
*Viral, bacterial or protozoal diseases causing myocarditis. | *Viral, bacterial or protozoal diseases causing myocarditis. | ||
| Line 406: | Line 406: | ||
|bgcolor="99FFCC" align="center"|'''Aldosteron antagonist''' | |bgcolor="99FFCC" align="center"|'''Aldosteron antagonist''' | ||
|bgcolor="99FFCC"| | |bgcolor="99FFCC"| | ||
|bgcolor="9ACD32" align="center"|'''EF | |bgcolor="9ACD32" align="center"|'''EF < 35%''' | ||
|bgcolor="9ACD32" align="center"|'''EF | |bgcolor="9ACD32" align="center"|'''EF < 35%''' | ||
|bgcolor="9ACD32" align="center"|'''EF | |bgcolor="9ACD32" align="center"|'''EF < 35%''' | ||
|- | |- | ||
|bgcolor="99FFCC" align="center"|'''Nitrate / Hydralazine''' | |bgcolor="99FFCC" align="center"|'''Nitrate / Hydralazine''' | ||
| Line 415: | Line 415: | ||
|bgcolor="9ACD32" align="center"|'''Afro-American''' | |bgcolor="9ACD32" align="center"|'''Afro-American''' | ||
|bgcolor="9ACD32" align="center"|'''Afro-American''' | |bgcolor="9ACD32" align="center"|'''Afro-American''' | ||
|- | |||
|bgcolor="99FFCC" align="center"|'''Ivabradine''' | |||
|bgcolor="99FFCC"| | |||
|bgcolor="9ACD32" align="center"|'''SR>75/min & EF<35%''' | |||
|bgcolor="9ACD32" align="center"|'''SR>75/min & EF<35%''' | |||
|bgcolor="9ACD32" align="center"|'''SR>75/min & EF<35%''' | |||
|- | |- | ||
|bgcolor="99FFCC" align="center"|'''Digoxin''' | |bgcolor="99FFCC" align="center"|'''Digoxin''' | ||
| Line 426: | Line 432: | ||
===Angiotensin-converting enzyme (ACE) inhibitors=== | ===Angiotensin-converting enzyme (ACE) inhibitors=== | ||
An ACE inhibitor | An ACE inhibitor is indicated for every patient with symptomatic systolic HF and an EF ≤40 % (NYHA class II-IV). (Class I recommendation, level of evidence A) Contraindications for the use of ACE inhibitors are: | ||
*History of angioedema | *History of angioedema | ||
*Bilateral renal artery stenosis | *Bilateral renal artery stenosis | ||
| Line 521: | Line 527: | ||
==Therapy of acute heart failure== | ==Therapy of acute heart failure== | ||
[[Image:acute_hf_flowchart.svg|400px|thumb|'''Figure 7.''' Flowchart acute HF.]] | |||
When severe symptoms of heart failure quickly develop over time, it is termed acute heart failure. In Table 6, common acute HF medications and their recommended doses are summarized. In Figure 7, a flowchart for the treatment of acute HF is depicted. The mainstay of acute heart failure therapy includes diuretics, vasodilators, inotropics and vasopressors. Moreover, oxygen and morphine can be added. | When severe symptoms of heart failure quickly develop over time, it is termed acute heart failure. In Table 6, common acute HF medications and their recommended doses are summarized. In Figure 7, a flowchart for the treatment of acute HF is depicted. The mainstay of acute heart failure therapy includes diuretics, vasodilators, inotropics and vasopressors. Moreover, oxygen and morphine can be added. | ||
{| class="wikitable" border="0" cellpadding="0" cellspacing="0" width="630px" | {| class="wikitable" border="0" cellpadding="0" cellspacing="0" width="630px" | ||
| Line 534: | Line 539: | ||
|- | |- | ||
|'''Diuretics''' | |'''Diuretics''' | ||
|Adequate blood pressure and signs of overfilling | |colspan="2"|Adequate blood pressure and signs of overfilling | ||
|- | |- | ||
| | | | ||
| Line 542: | Line 546: | ||
Renal failure | Renal failure | ||
|40 mg | |40 mg | ||
125 mg – max 1000 mg | |||
|- | |- | ||
| | | | ||
| Line 549: | Line 553: | ||
Renal failure | Renal failure | ||
|1 mg | |1 mg | ||
3 mg – max 25 mg | |||
|- | |- | ||
|'''Vasodilators''' | |'''Vasodilators''' | ||
|Adequate blood pressure and signs of severe overfilling | |colspan="2"|Adequate blood pressure and signs of severe overfilling | ||
|- | |||
| | | | ||
*Nitroglycerine i.v. | *Nitroglycerine i.v. | ||
| | | | ||
|20 µg/min – max 200 µg/min (guided by blood pressure) | |20 µg/min – max 200 µg/min (guided by blood pressure) | ||
|- | |||
| | | | ||
*Nitroprusside i.v. | *Nitroprusside i.v. | ||
| | ||Hypertensive crisis or in combination with inotropic in case of a cardiogenic shock | ||
|Hypertensive crisis or in combination with inotropic in case of a cardiogenic shock | |||
|0.3 µg/kg/min – max 5 µg/kg/min (guided by blood pressure) | |0.3 µg/kg/min – max 5 µg/kg/min (guided by blood pressure) | ||
|- | |- | ||
| Line 645: | Line 648: | ||
|- | |- | ||
|valign="top"| | |valign="top"| | ||
*Lisinopril | *Lisinopril | ||
| | | | ||
|Start 2.5-5mg | |Start 2.5-5mg | ||
| Line 794: | Line 786: | ||
*Valsartan | *Valsartan | ||
| | | | ||
|Start | |Start 40mg twice daily | ||
3-5 weeks | 3-5 weeks 80mg twice daily. | ||
>7 weeks | >7 weeks 160mg twice daily. | ||
|- | |- | ||
|colspan="3" bgcolor="#F0F0F0 "|'''Hydralazine and isosorbide dinitrate (H-ISDN)''' | |colspan="3" bgcolor="#F0F0F0 "|'''Hydralazine and isosorbide dinitrate (H-ISDN)''' | ||