Cardiology

Question 1

Pharmacotherapy for HF-REF

Answer 1

• ACE-I
• BB (if NYHA III/IV, let cards start)
• MRA: spironolactone 12.5-50 mg daily
  
  • if EF <= 30% + chronic HF III/IV despite optimization
• Digoxin: reduces hospitalizations, may add-on if symptomatic
• Loop diuretic for symptoms
• ICD/CRT

Question 2

Pharmacotherapy for HF-PEF

Answer 2

• no evidence for mortality benefit of any drugs but:
• ACE-I
• BB if prev MI or angina
• MRA if high BNP, K <5 and eGFR >=30 (evidence improved QOL)
• loop diuretics PRN

Question 3

Criteria for referral for ICD or CRT in HF

Answer 3

• ICD: EF <30%
• CRT: EF <35% and NSR and QRS >130 ms from LBBB or >150 ms from other block