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1) In patients with systolic Heart Failure, Beta blockers(BB) should be started after the fluid
retention has been treated.
2) Systolic Heart Failure (symptomatic) USE BB, ACEI/ARB, Spironolactone/Eplerenone.
3) Digoxin is also indicated in patients with both systolic failure and chronic atrial fibrillation.
4) Addition of a fixed-dose combination of hydralazine/isosorbide dinitrate to an ACE inhibitor and
beta blocker is recommended in African-American patients with NYHA class IIIV heart failure.
5) Device therapy should be considered in addition to drug therapy in appropriate patients, as
indicated. Primary prevention- LVEF less than 35% on medical therapy
6) Signs of Edema or Fluid overload treated with LOOP DIURETICS ( Furosemide, torsemide,
bumetamide), Not thiazide as first line.
7) DRUGS THAT IMPROVE SURVIVAL/ cause REVERSE REMODELING ( IMPROVEMENT IN LVEF AND
DECREASE IN LV SIZE
- Beta Blockers ( carvedilol, metoprolol succinate, bisoprolol)
- ACE Inhibitors/ Angiotensin receptor blockers ( enalapril/ Losartan etc)
- Aldosterone antagonist ( Spironolactone, Eplerenone)
- Hydralazine/ISDN in selected patients African American
8) DRUGS THAT DO NOT IMPROVE SURVIVAL in patients with systolic HF: Digoxin, Diuretics
9) Drug that reduced HF hospitalization when added to medical therapy Digoxin
10) DRUGS THAT INCREASE MORTALITY/DECREASE SURVIVAL inotropes dobutamine and
milrinone.
11) DRUGS THAT SHOULD NOT BE USED IN PATIENTS WITH Systolic CHF: NSAIDS, Class I
antiarrhythmics, Calcium channel Blockers (verapamil, diltiazem)
12) VASODILATORS TO BE USED INPATIENT SETTING e.g acute decompensated state, acute
pulmonary edema: Nitroprusside, Nitroglycerin
13) COMMONLY USED INOTROPES in SYSTOLIC HF: Dobutamine, milrinone, dopamine,
norepinephrine.
14) Dobutamine Beta 1 agonist increase in contractility
15) Milrinone: PDE 3 inhibitor: increases contractility, vasodilation.
16) Nesiritide: used for treatment of dyspnea from CHF, also a vasodilator, recombinant BNP, used
IV, NOT RECOMMENDED FOR ROUTINE USE.
17) Drugs used in HF which are contraindicated in pregnancy: ACE inhibitors, ARB, Spironolactone,
Eplerenone.
FEW IMPORTANT SIDE EFFECTS OF DRUGS USED TO TREAT HEART FAILURE: ( this is not
comprehensive list of side effects, please refer to your textbooks for entire list)
ABBREVIATIONS USED: