therapy : Heart Failure

  • Drug therapy
    • Diuretics
      • Reduce edema, pulmonary venous pressure, and preload
      • Promote sodium and water excretion
      • Loop diuretics
      • Thiazide diuretics
      • Monitor potassium levels (hypokalemia)
    • RAAS inhibitors
      • ACE inhibitors
      • Angiotensin II receptor blockers
      • Aldosterone antagonists
      • Monitor potassium levels (hyperkalemia)
    • β-Blockers
    • Vasodilators
      • Nitrates
    • Combination therapy
      • BiDil
    • Positive inotropic agents
      • Digitalis
    • Inhibitor of cardiac sinus node
      • Ivabradine (Corlanor)
      • Must be in sinus rhythm with resting HR of > 70 bpm and taking highest dose β-blockers
        • Inhibits sinus node
        • Reduces HR
        • Decreases risk of hospitalization for worsening HF
  • Nutritional therapy
    • Low sodium diet
    • Individualize recommendations and consider cultural background www.nhlbi.nih.gov/health/index.htm#recipes
    • Recommend Dietary Approaches to Stop Hypertension (DASH) diet
    • Sodium is usually restricted to 2 g/day
    • Fluid restriction not generally required
    • If required, < 2L/day
      • Ice chips, gum, hard candy, ice pops to help thirst
    • Daily weights important
      • Same time, same clothing each day
    • Weight gain of 3 lb (1.4 kg) over 2 days or a 3- to 5-lb (2.3 kg) gain over a week should be reported to HCP