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cardio:heart_failure:start [2026/02/12 23:58] – [SGLT2 Inhibitors] andrew2393cnscardio:heart_failure:start [2026/02/13 18:00] (current) – [Diuretics (Symptom Control)] andrew2393cns
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 -------------------------------------------------------------------- --------------------------------------------------------------------
  
 +==== Remodeling Prevention ====
 +
 +Chronic neurohormonal activation causes:
 +
 +  * • LV dilation
 +  * • Fibrosis
 +  * • Progressive decline in EF
 +
 +GDMT prevents remodeling.
 +
 +--------------------------------------------------------------------
  
  
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 All patients with HFrEF should receive: All patients with HFrEF should receive:
  
-1. [[cardio:raas:arni|ARNI]] (preferred) OR [[cardio:raas:acei|ACE Inhibitor]] OR [[cardio:raas:arb|ARB]] +  - 1. [[cardio:raas:arni|ARNI]] (preferred) OR [[cardio:raas:acei|ACE Inhibitor]] OR [[cardio:raas:arb|ARB]] 
-2. [[cardio:beta_blockers:start|Evidence-Based Beta-Blocker]] +  - 2. [[cardio:beta_blockers:start|Evidence-Based Beta-Blocker]] 
-3. [[cardio:hf:mra|Mineralocorticoid Receptor Antagonist]] +  - 3. [[cardio:hf:mra|Mineralocorticoid Receptor Antagonist]] 
-4. [[endocrine:sglt2:start|SGLT2 Inhibitor]]+  - 4. [[endocrine:sglt2:start|SGLT2 Inhibitor]]
  
 These therapies reduce mortality and hospitalization. These therapies reduce mortality and hospitalization.
  
--------------------------------------------------------------------- +----
 ==== RAAS Inhibition ==== ==== RAAS Inhibition ====
  
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 -------------------------------------------------------------------- --------------------------------------------------------------------
  
-===== Secondary / Add-On Therapies =====+==== Secondary / Add-On Therapies ====
  
 [[cardio:hf:hydralazine_isdn|Hydralazine + Isosorbide Dinitrate]] [[cardio:hf:hydralazine_isdn|Hydralazine + Isosorbide Dinitrate]]
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 • Soluble guanylate cyclase stimulator • Soluble guanylate cyclase stimulator
  
---------------------------------------------------------------------+---- 
  
-===== Diuretics (Symptom Control) =====+==== Diuretics (Symptom Control) ====
  
 Diuretics DO NOT reduce mortality. Diuretics DO NOT reduce mortality.
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 Used for congestion relief: Used for congestion relief:
  
-• [[cardio:diuretics:furosemide|Furosemide]] +  * • [[cardio:diuretics:furosemide|Furosemide]] 
-• [[cardio:diuretics:torsemide|Torsemide]]+  * • [[cardio:diuretics:torsemide|Torsemide]]
  
 Effect: Effect:
  
-• ↓ Preload +  * • ↓ Preload 
-• ↓ Pulmonary edema +  * • ↓ Pulmonary edema 
-• Symptom improvement only+  * • Symptom improvement only
  
 -------------------------------------------------------------------- --------------------------------------------------------------------
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 ===== **HFpEF** ===== ===== **HFpEF** =====
  
-No strong mortality-reducing therapies except:+**No strong mortality-reducing therapies except**:
  
 • [[endocrine:sglt2:start|SGLT2 Inhibitors]] • [[endocrine:sglt2:start|SGLT2 Inhibitors]]
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 Management focuses on: Management focuses on:
  
-• Blood pressure control +  * • Blood pressure control 
-• Diuretics for congestion +  * • Diuretics for congestion 
-• Treating atrial fibrillation +  * • Treating atrial fibrillation 
-• Managing ischemia+  * • Managing ischemia
  
 -------------------------------------------------------------------- --------------------------------------------------------------------
  
-# Acute Decompensated Heart Failure 
  
-===== Pulmonary Edema =====+ 
 +===== **Acute Decompensated Heart Failure** ===== 
 + 
 +==== Pulmonary Edema ====
  
 • [[cardio:diuretics:furosemide|IV Loop Diuretics]] • [[cardio:diuretics:furosemide|IV Loop Diuretics]]
 +
 • [[cardio:angina:nitroglycerin|Nitroglycerin]] • [[cardio:angina:nitroglycerin|Nitroglycerin]]
 +
 • Oxygen • Oxygen
 +
 • Positive pressure ventilation if needed • Positive pressure ventilation if needed
  
 -------------------------------------------------------------------- --------------------------------------------------------------------
  
-===== Cardiogenic Shock =====+==== Cardiogenic Shock ====
  
 • [[cardio:inotropes:dobutamine|Dobutamine]] • [[cardio:inotropes:dobutamine|Dobutamine]]
 +
 • [[cardio:inotropes:dopamine|Dopamine]] • [[cardio:inotropes:dopamine|Dopamine]]
  
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 -------------------------------------------------------------------- --------------------------------------------------------------------
  
-# Remodeling Prevention 
- 
-Chronic neurohormonal activation causes: 
- 
-• LV dilation 
-• Fibrosis 
-• Progressive decline in EF 
- 
-GDMT prevents remodeling. 
- 
--------------------------------------------------------------------- 
  
-# Clinical Pearls+==== Clinical Pearls ====
  
-✔ Heart failure is a neurohormonal disease   +  * ✔ Heart failure is a neurohormonal disease   
-✔ Diuretics improve symptoms, not survival   +  * ✔ Diuretics improve symptoms, not survival   
-✔ Four pillars reduce mortality   +  * ✔ Four pillars reduce mortality   
-✔ Only specific beta-blockers reduce mortality   +  * ✔ Only specific beta-blockers reduce mortality   
-✔ SGLT2 inhibitors benefit even non-diabetics   +  * ✔ SGLT2 inhibitors benefit even non-diabetics   
-✔ Start low, titrate slowly  +  * ✔ Start low, titrate slowly  
  
 -------------------------------------------------------------------- --------------------------------------------------------------------
cardio/heart_failure/start.1770940696.txt.gz · Last modified: by andrew2393cns