Heart Failure Flashcards
Frequent nocturnal hypoxemia in a patient with normal BMI and advanced heart failure suggests possible central sleep apnea.
Central sleep apnea
CSA in HF is characterized by Cheyne-Stokes breathing, oscillating tidal volume with hyperventilation the periods of hypopnea, and apnea.
Management of HFpEF?
Specific therapies to reduce hospitalization and possibly mortality:
• MRAs (eg, spironolactone)
• SGLT-2 inhibitors (eg, dapagliflozin)
Treat Afterload reduction (blood pressure <130/80 mm Hg)- anti hypertensives
Spiranolactone
Treat volume overload -Diuretics
Treat exacerbating causes (a fib - rate control, CAD-coronary revascularization treat exacerbating conditions.)
Exercise training and cardiac rehab
Indications for CRT?
Cardiac resynchronization therapy with a biventricular pacemaker is indicated for
Symptomatic patients with left ventricular ejection fraction (LVEF) <35% and left bundle branch block with QRS duration >150 msec.
However, patient should first receive optimal medical therapy for at least 3 months to evaluate for LVEF recovery.
When is an ICD indicated ?
What can patients get in the interim?
Other indications?
What if the patient doesn’t undergo PCI ?
Place an ICD in patients with persistent LVEF <30% (or <35% with heart failure symptoms) on repeat evaluation 3 months after revascularization.
High-risk patients may receive a temporary wearable cardiac defibrillator (LifeVest) during this period.
Prior VF or unstable VT without reversible cause,
Prior Sustained VT with underlying cardiomyopathy.
Reassessed for ICD placement 40 days after a myocardial infarction.
