Heart failurehf with preservedejection

Lvef >

Epidemiology
- Should have som
AETIOLOGY
- Any structural disease
o Pericardium

Final pathophysiological pathway

- Sympathetic NS activation
- RAAS activation

Symptoms
- SOB
o How far can they walk before they get SOB?
o How many flights of stairs?
- Orthopnoea-SOB while lying down
- Paroxysmal Nocturnal dyspnea
- Reduced exercise tolerance
NY HA
- How bad is the person being affected by HF
Diagnosis algorithm
- Ask about SOB symptom
- What heart disease they have
- Radio/chemotherapy
- Blood test for BNP
- Echocardio-cause of hf and to look at which category of HF they are in.
Management of chronic HF
- Underlying cause
- Assess CV risk- most hf are caused by other diseases. Dont smoke, limit alcohol, manage
diabetes, optimize BP, atrial fibrillation
- Non-pharmacological interventions- lifestyle,device/transplant
- Pharmacological

LIFESTYLE
- Salt intake (6g avg) limit to 4g

Sns activation
- B-blockers
- Acei , arb, ARNI, MRA
- HYD/ISMN
- Ivabradine
Symptom relief
- Diuretics
- Digoxin-late stage.
- IV iron therapy. Make sure the person is not anaemic.
 - ESC 2016 GUIDELINe
o Green
o Yellow
o White
Why you want heart rate below 70? Coronary perfusion is better. More filling time/relaxation
Sinus rhythm- risk of
Add ARNI 3rd line
Digoxin, H-ISDN

ACEi/ARB
- CI
o History of angioedema lips and passage ways balloon up
o Known bilateral kidney artery stenosis
- Cautions
o Hyperkalaemia
o Renal dysfunction
o Hypotension
- Drug interaction
o K SUPPS
o Low sat subs with high K

Start with a low does and double the dose at not less that two weekly intervals.
Cough-

B-blockers
- Asthma
- Heart block
- Hypotension
- Cautions
o Severe HF IV
- Drug inte
o Ccb
Start with a low dose and double the dose.

MRA
- Cautions
o Hyperkalaemi
o Renal dusfuntiion
- Drug inte
o K supps
o K sparing diuretics
Start with low dose.
How to counsel patients with these drugs.
Eplerenone- expensive, less s/e b/c less potent.
Stop if N/V, diarrhea

Angiotensin/neprilysin
- Inhibitn of nep prevent breakdown of bnp and anp therefore increases diuresis.
 o If the pt is already on acei then acei stop it 36 hrs before
Hydralzine isosorbide
- 1st line - Use for ppl who cant tolerate acei OR ARB
- 2nd line afro/carrib
- Hydralazine can actually increase the HR and cause fluid retention.
o Associated with drug induced lupus

Ivabradine
- Atrial fibrillation- not used

Digoxin
-