733
edits
Heart Failure: Difference between revisions
Jump to navigation
Jump to search
→Therapy of acute heart failure
| (9 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 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 432: | 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 527: | 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 540: | Line 539: | ||
|- | |- | ||
|'''Diuretics''' | |'''Diuretics''' | ||
|Adequate blood pressure and signs of overfilling | |colspan="2"|Adequate blood pressure and signs of overfilling | ||
|- | |- | ||
| | | | ||
| Line 557: | Line 555: | ||
3 mg – max 25 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 651: | Line 648: | ||
|- | |- | ||
|valign="top"| | |valign="top"| | ||
*Lisinopril | *Lisinopril | ||
| | | | ||
|Start 2.5-5mg | |Start 2.5-5mg | ||