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Manejo para falla cardiaca 4, Apuntes de Cardiología

Manejo para falla cardiaca segun varios articulos

Tipo: Apuntes

2019/2020

Subido el 18/10/2020

cleir-angarita
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STAGE A
At high risk for HF but without
structural heart disease or
symptoms of HF
STAGE B
Structural heart disease but
without signs or symptoms
of HF
STAGE C
Structural heart disease with
prior or current symptoms
of HF
STAGE D
Refractory HF
e.g., Patients with:
Previous MI
LV remodeling including LV
Hand low EF
Asymptomatic valvular
disease
e.g., Patients with:
Known structural heart
disease and
HF signs and symptoms
e.g., Patients with:
Marked HF symptoms at
rest
Recurrent hospitalizations
despite GDMT
THERAPY
Goals
Control symptoms
Improve HRQOL
Patient education
Prevent hospitalization
Prevent mortality
Strategies
Identification of comorbidities
Treatment
Diuresis to relieve symptoms
of congestion
Follow guideline driven
indications for comorbidities,
e.g., HTN, AF, CAD, DM
Revascularization or valvular
surgery as appropriate
THERAPY
Goals
Control symptoms
Improve HRQOL
Patient education
Prevent hospitalization
Prevent mortality
Drugs for routine use
Diuretics for fluid retention
ACEI or ARB
ARNI
Beta blockers
Aldosterone antagonists
Drugs for use in selected
patients
Hydralazine/isosorbide dinitrate
ACEI and ARB
Ivabradine
Digoxin
Inselected patients
CRT
ICD
Revascularization or valvular
surgery as appropriate
HFpEF HFrEF
THERAPY
Goals
Prevent HF symptoms
Prevent further cardiac
remodeling
Drugs
ACEI or ARB as appropriate
Beta blockers as
appropriate
In selected patients
ICD
Revascularization or
valvular surgery as
appropriate
THERAPY
Goals
Control symptoms
Improve HRQOL
Reduce hospital
readmissions
Establish patient’s end-of-
life goals
Options
Advanced care measures
Heart transplant
Chronic inotropes
Temporary or permanent
MCS
Experimental surgery or
drugs
Palliative care and hospice
ICD deactivation
e.g., Patients with:
HTN
Atherosclerotic disease
DM
Obesity
Metabolic syndrome
OR
Patients
Using cardiotoxins
With family history of
cardiomyopathy
THERAPY
Goals
Heart healthy lifestyle
Prevent vascular, coronary
disease
Prevent LV structural
abnormalities
Drugs
ACEI or ARB in appropriate
patients for vascular
disease or DM
Statins as appropriate
Development
of symptoms
of HF
Refractory
symptoms
of HF at rest,
despite GDMT
Structural
heart disease
Stages in the development of HF and recommended therapy by stage. ACEI indicates angiotensin-converting
enzyme inhibitor; AF, atrial fibrillation; ARB, angiotensin-receptor blocker; CAD, coronary artery disease;
CRT, cardiac resynchronization therapy; DM, diabetes mellitus; EF, ejection fraction; GDMT, guideline-
directed medical therapy; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HFrEF,
heart failure with reduced ejection fraction; HRQOL, health-related quality of life; HTN, hypertension; ICD,
implantable cardioverter-defibrillator; LV, left ventricular; LVH, left ventricular hypertrophy; MCS, mechanical
circulatory support; and MI, myocardial infarction. Adapted from Hunt et al.3
Yancy CW et al., ACCF/AHA Guideline for the Management of Heart Failure, Circulation, 10/15/13.
Yancy CW et al., 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management
of Heart Failure, Circulation, 08/08/2017.
AT RISK FOR HEART FAILURE HEART FAILURE

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STAGE A

At high risk for HF but without structural heart disease or symptoms of HF

STAGE B

Structural heart disease but without signs or symptoms of HF

STAGE C

Structural heart disease with prior or current symptoms of HF

STAGE D

Refractory HF e.g., Patients with:

  • Previous MI
  • LV remodeling including LV Hand low EF
  • Asymptomatic valvular disease e.g., Patients with: - Known structural heart disease and - HF signs and symptoms e.g., Patients with: - Marked HF symptoms at rest - Recurrent hospitalizations despite GDMT THERAPY Goals
  • Control symptoms
  • Improve HRQOL
  • Patient education
  • Prevent hospitalization
  • Prevent mortality Strategies
  • Identification of comorbidities Treatment
  • Diuresis to relieve symptoms of congestion
  • Follow guideline driven indications for comorbidities, e.g., HTN, AF, CAD, DM
  • Revascularization or valvular surgery as appropriate

THERAPY

Goals

  • Control symptoms
  • Improve HRQOL
  • Patient education
  • Prevent hospitalization
  • Prevent mortality Drugs for routine use
  • Diuretics for fluid retention
  • ACEI or ARB
  • ARNI
  • Beta blockers
  • Aldosterone antagonists Drugs for use in selected patients
  • Hydralazine/isosorbide dinitrate
  • ACEI and ARB
  • Ivabradine
  • Digoxin Inselected patients
  • CRT
  • ICD
  • Revascularization or valvular surgery as appropriate HFpEF HFrEF THERAPY Goals
  • Prevent HF symptoms
  • Prevent further cardiac remodeling Drugs
  • ACEI or ARB as appropriate
  • Beta blockers as appropriate In selected patients
  • ICD
  • Revascularization or valvular surgery as appropriate

THERAPY

Goals

  • Control symptoms
  • Improve HRQOL
  • Reduce hospital readmissions
  • Establish patient’s end-of- life goals Options
  • Advanced care measures
  • Heart transplant
  • Chronic inotropes
  • Temporary or permanent MCS
  • Experimental surgery or drugs
  • Palliative care and hospice
  • ICD deactivation e.g., Patients with:
  • HTN
  • Atherosclerotic disease
  • DM
  • Obesity
  • Metabolic syndrome OR Patients
  • Using cardiotoxins
  • With family history of cardiomyopathy THERAPY Goals
  • Heart healthy lifestyle
  • Prevent vascular, coronary disease
  • Prevent LV structural abnormalities Drugs
  • ACEI or ARB in appropriate patients for vascular disease or DM
  • Statins as appropriate Development of symptoms of HF Refractory symptoms of HF at rest, despite GDMT Structural heart disease Stages in the development of HF and recommended therapy by stage. ACEI indicates angiotensin-converting enzyme inhibitor; AF, atrial fibrillation; ARB, angiotensin-receptor blocker; CAD, coronary artery disease; CRT, cardiac resynchronization therapy; DM, diabetes mellitus; EF, ejection fraction; GDMT, guideline- directed medical therapy; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; HRQOL, health-related quality of life; HTN, hypertension; ICD, implantable cardioverter-defibrillator; LV, left ventricular; LVH, left ventricular hypertrophy; MCS, mechanical circulatory support; and MI, myocardial infarction. Adapted from Hunt et al.^3 Yancy CW et al., ACCF/AHA Guideline for the Management of Heart Failure, Circulation, 10/15/13. Yancy CW et al., 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure, Circulation, 08/08/2017.

AT RISK FOR HEART FAILURE HEART FAILURE