Congestive Heart Failure课件.pptVIP

Classification of Heart Failure New York Heart Association (NYHA) Class I – symptoms of HF only at levels that would limit normal individuals. Class II – symptoms of HF with ordinary exertion Class III – symptoms of HF on less than ordinary exertion Class IV – symptoms of HF at rest Classification of Heart Failure (cont.) ACC/AHA Guidelines Stage A – High risk of HF, without structural heart disease or symptoms Stage B – Heart disease with asymptomatic left ventricular dysfunction Stage C – Prior or current symptoms of HF Stage D – Advanced heart disease and severely symptomatic or refractory HF Chronic Treatment of Systolic Heart Failure Correction of systemic factors Thyroid dysfunction Infections Uncontrolled diabetes Hypertension Lifestyle modification Lower salt intake Alcohol cessation Medication compliance Maximize medications Discontinue drugs that may contribute to heart failure (NSAIDS, antiarrhythmics, calcium channel blockers) Order of Therapy Loop diuretics ACE inhibitor (or ARB if not tolerated) Beta blockers Digoxin Hydralazine, Nitrate Potassium sparing diuretcs Diuretics Loop diuretics Furosemide, buteminide For Fluid control, and to help relieve symptoms Potassium-sparing diuretics Spironolactone, eplerenone Help enhance diuresis Maintain potassium Shown to improve survival in CHF ACE Inhibitor Improve survival in patients with all severities of heart failure. Begin therapy low and titrate up as possible: Enalapril – 2.5 mg po BID Captopril – 6.25 mg po TID Lisinopril – 5 mg po QDaily If cannot tolerate, may try ARB Beta Blocker therapy Certain Beta blockers (carvedilol, metoprolol, bisoprolol) can improve overall and event free survival in NYHA class II to III HF, probably in class IV. Contraindicated: Heart rate 60 bpm Symptomatic bradycardia Signs of peripheral hypoperfusion COPD, asthma PR interval 0.24 sec, 2nd or 3rd degree block Hydralazine plus Nitrates Dosing: Hydralazine Started at 25 mg po TID, titrated up to 100 mg po TID Isosorbi