CHF -2

Question 1

What are general recommendations for patients with CHF?

Answer 1

1) Fluids < 2L per day
2) Na intake < 2 gm / day
3) Alcohol restriction; <2/day (men), <1/day (women)
4) Exercise 30 minutes, 5 days/week
5) Tx of OSA
6) Goals of Care Discussions

Question 2

What is the initial dose of Lisinopril for HFrEF? What is the goal dose? How frequently do you titrate up the medicine?

Answer 2

Start = 2.5-5.0 mg daily
Goal = 20-40 mg daily
Titrate up every 7-14 days.

Question 3

What is the initial dose of Losartan for HFrEF? What is the goal dose? How frequently do you titrate up the medicine?

Answer 3

Start = 25-50 mg daily
Goal = 50-150 mg daily
Titrate up every 7-14 days.

Question 4

What is the initial dose of Coreg for HFrEF? What is the goal dose? How frequently do you titrate up the medicine?

Answer 4

Start = 3.125 mg BID
Goal = 50 mg BID
Titrate up every 7-14 days.

Question 5

What is the initial dose of Metoprolol Succinate (Toprol) for HFrEF? What is the goal dose? How frequently do you titrate up the medicine?

Answer 5

Start = 12.5 mg - 25 mg daily
Goal = 200 mg daily
Titrate up every 7-14 days.

Question 6

What is the initial dose of Spironolactone for HFrEF? What is the goal dose?

Answer 6

Start = 12.5 mg - 25 mg daily
Goal = 25 mg - 50 mg (25 mg x 1-2/day)

Question 7

What is the dose of Metolazone?

What instructions are needed for taking this medication with a loop diuretic?

Answer 7

2.5 mg daily

Take 30-60 minutes before the loop-diuretic

Question 8

When to put in a defibrillator? What additional criteria would indicate for a biventricular pacer (i.e. Cardiac Resynchronization Therapy)?

Answer 8

1) NYHA Stage 2-3
2) On Goal-Directed Therapy
3) Life Expectancy > 1 year
4) EF < 35%
5) Are atleast 40 days from MI/diagnosis

Bi-Ventricular Pacer would be indicated when there is ventricular dyssynchrony —> meaning evidence of either a LBBB or a QRS > 150 msec.