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rt failure in adults
Treatment of chronic heart failure
T he obje c tiv e is to im p r ov e the p r ognos is a nd q u a lity of life .
– D ie ta r y m od ific a tion: r e d u c e s a lt inta ke to lim it flu id r e te ntion, nor m a l flu id
inta ke
(e xc e p t in the c a s e of a na s a r c a : 7 5 0 m l/ 2 4 hou r s ).
– Treatment of fluid retention
•Initia l the r a p y: furosemide P O
D u r ing c onge s tiv e e p is od e s : 4 0 to 1 2 0 m g onc e d a ily. W he n the c onge s tiv e
e p is od e
is c ontr olle d , r e d u c e the d os e to 2 0 m g onc e d a ily.
•T he d os e c a n be inc r e a s e d (u p to 2 4 0 m g/ d a y). If the s e d os e s a r e s till
ine ffe c tiv e ,
a d d in g hydrochlorothiazide P O ( 2 5 t o 5 0 m g/ d a y for s e v e r a l d a ys ) m a y be
c ons id e r e d .
•I n c a s e of t r e a t m e n t fa ilu r e a n d in t h e a bs e n c e of s e v e r e r e n a l
im p a ir m e n t ,
fu r os e m id e m a y be c om bine d w ith spironolactone P O : 2 5 m g onc e d a ily.
•If p r e s e nt, d r a ina ge of p le u r a l e ffu s ions by ne e d le a s p ir a tion.
Note: the r is ks of a d m inis te r ing d iu r e tic s inc lu d e : d e hyd r a tion, hyp ote ns ion, hyp o-
or
hyp e r ka la e m ia , hyp ona tr e m ia , a nd r e na l im p a ir m e nt. C linic a l m onitor ing
(hyd r a tion,
blood p r e s s u r e ) a n d if p os s ible m e t a bolic m on it or in g ( s e r u m e le c t r olyt e s
a nd
c r e a tinine ) , s h ou ld be d one r e gu la r ly, e s p e c ia lly if giv in g h igh d os e s or in
e lednaelarplyril P O : 5 m g onc e d a ily for the fir s t w e e k, the n d ou ble the d os e e a c h w e
p a tie nts .
– Baseline treatment
•Ac nhgeiomteisnstriyn (cthoenvr ee irstinag reisnzkyomf heyp(Ae rCkaEle )minihaibitaornsd ar reenathleimfirpsat ilrinme etrnet)a. tm e nt.
Sta r t
w ith low d os e s , e s p e c ia lly in p a tie nts w ith low blood p r e s s u r e , r e na l
im p a ir m e nt,
hyp ona tr e m ia , or c onc u r r e nt d iu r e tic tr e a tm e nt.
1
u ntil the e ffe c tiv e d os e is r e a c he d , u s u a lly a r ou nd 1 0 to 4 0 m g onc e d a ily
or in 2
d iv id e d d os e s . Inc r e a s e s in the d os e a r e m a d e w hile m onitor ing the
p a tie nt's blood
p r e s s u r e ( t h e s ys t olic p r e s s u r e s h ou ld r e m a in a bov e 9 0 m m H g) a n d
blood
2
In p a tie nts tr e a te d w ith d iu r e tic s , r e d u c e the d os e of the d iu r e tic if p os s ible
w hile
intr od u c ing A C E inhibitor s .
If the p a tie nt is ta king high d os e s of d iu r e tic s , r e d u c e the initia l d os e of
e na la p r il to
ha lf (r is k of s ym p tom a tic hyp ote ns ion).
D o not c om bine A C E inhibitor s a nd s p ir onola c tone (r is k of s e v e r e
hyp e r ka le m ia ).
•D igita lis glyc os id e s a r e on ly in d ic a te d in p a tie nts w ith p r ov e n a tr ia l fibr illa tion
(E C G ).
If the r e a r e no c ontr a -ind ic a tions (br a d yc a r d ia , u nid e ntifie d r hythm
Treatment of chronic heart failure
T he obje c tiv e is to im p r ov e the p r ognos is a nd q u a lity of life .
– D ie ta r y m od ific a tion: r e d u c e s a lt inta ke to lim it flu id r e te ntion, nor m a l flu id
inta ke
(e xc e p t in the c a s e of a na s a r c a : 7 5 0 m l/ 2 4 hou r s ).
– Treatment of fluid retention
•Initia l the r a p y: furosemide P O
D u r ing c onge s tiv e e p is od e s : 4 0 to 1 2 0 m g onc e d a ily. W he n the c onge s tiv e
e p is od e
is c ontr olle d , r e d u c e the d os e to 2 0 m g onc e d a ily.
•T he d os e c a n be inc r e a s e d (u p to 2 4 0 m g/ d a y). If the s e d os e s a r e s till
ine ffe c tiv e ,
a d d in g hydrochlorothiazide P O ( 2 5 t o 5 0 m g/ d a y for s e v e r a l d a ys ) m a y be
c ons id e r e d .
•I n c a s e of t r e a t m e n t fa ilu r e a n d in t h e a bs e n c e of s e v e r e r e n a l
im p a ir m e n t ,
fu r os e m id e m a y be c om bine d w ith spironolactone P O : 2 5 m g onc e d a ily.
•If p r e s e nt, d r a ina ge of p le u r a l e ffu s ions by ne e d le a s p ir a tion.
Note: the r is ks of a d m inis te r ing d iu r e tic s inc lu d e : d e hyd r a tion, hyp ote ns ion, hyp o-
or
hyp e r ka la e m ia , hyp ona tr e m ia , a nd r e na l im p a ir m e nt. C linic a l m onitor ing
(hyd r a tion,
blood p r e s s u r e ) a n d if p os s ible m e t a bolic m on it or in g ( s e r u m e le c t r olyt e s
a nd
c r e a tinine ) , s h ou ld be d one r e gu la r ly, e s p e c ia lly if giv in g h igh d os e s or in
e lednaelarplyril P O : 5 m g onc e d a ily for the fir s t w e e k, the n d ou ble the d os e e a c h w e
p a tie nts .
– Baseline treatment
•Ac nhgeiomteisnstriyn (cthoenvr ee irstinag reisnzkyomf heyp(Ae rCkaEle )minihaibitaornsd ar reenathleimfirpsat ilrinme etrnet)a. tm e nt.
Sta r t
w ith low d os e s , e s p e c ia lly in p a tie nts w ith low blood p r e s s u r e , r e na l
im p a ir m e nt,
hyp ona tr e m ia , or c onc u r r e nt d iu r e tic tr e a tm e nt.
1
u ntil the e ffe c tiv e d os e is r e a c he d , u s u a lly a r ou nd 1 0 to 4 0 m g onc e d a ily
or in 2
d iv id e d d os e s . Inc r e a s e s in the d os e a r e m a d e w hile m onitor ing the
p a tie nt's blood
p r e s s u r e ( t h e s ys t olic p r e s s u r e s h ou ld r e m a in a bov e 9 0 m m H g) a n d
blood
2
In p a tie nts tr e a te d w ith d iu r e tic s , r e d u c e the d os e of the d iu r e tic if p os s ible
w hile
intr od u c ing A C E inhibitor s .
If the p a tie nt is ta king high d os e s of d iu r e tic s , r e d u c e the initia l d os e of
e na la p r il to
ha lf (r is k of s ym p tom a tic hyp ote ns ion).
D o not c om bine A C E inhibitor s a nd s p ir onola c tone (r is k of s e v e r e
hyp e r ka le m ia ).
•D igita lis glyc os id e s a r e on ly in d ic a te d in p a tie nts w ith p r ov e n a tr ia l fibr illa tion
(E C G ).
If the r e a r e no c ontr a -ind ic a tions (br a d yc a r d ia , u nid e ntifie d r hythm
