General Treatment Guideline

1. Control factors that cause progression of heart failure

2. Moderate sodium restriction
3. Immunize with influenza and pneumococcal vaccines
4. Encourage physical activities
5. Weight self daily
 Sudden weight gain  Early sign of fluid build up
 Later signs: SOB, need extra pillows to sleep, swollen ankles/hands/feet
 Weight self qam, empty bladder, same amount of clothes, same scale
 Increase/decrease in 2 lb in 2 days or 5 lbs in a week is too much
6. Monitor for changes in serum K
 Sx’s: muscle weakness
Avoid to use:
1. Anti-arrhythmic agents – avoid flecainide
 Amiodarone has shown not to adversely affect survivial
 Beta-blockers and CCB are usually fine
2. Glitazones
 Associated with fluid retention, worsening of HF symptoms
3. Non-dihydropyridine CCB
 Lead to worsening of systolic HF
 Associated with increase risk of CV events
4. NSAIDs
 Causes sodium retention and peripheral edema
 ASA 81 is ok
Drug Indication MOA Dose / dosage Side Effects
Loop Diuretics – Should be Rx’ed to: all patients who have Acts at the loop of Henle Initial Dose: K and Mg depletion
Furosemide, Bumetanide evidenced of fluid retention; most patients
Increase Na excretion by up to Furosemide: 20-40 mg Dehydration
with history of fluid retention
25% OD/BID Hypotension
Preferred diuetic for most patients with HF Bumetanide: 0.5-1.0 mg
Azotemia – high level of nitrogen
Decrease efficacy with severely impaired OD/BID
waste in blood, indicates decreasing
renal function
Torsemide: 10-20 mg OD fluid too quickly
Max Dose: Rash, hearing problems?
Furosemide: 600 mg Monitor for e-lyte levels
Bumetanide: 10 mg
Torsemide: 200 mg
Thiazides – May be preferred in hypertensive patients – Act on the distal portion of
Hydrochlorothiazide, more anti-HTN effect tubule
metalozone Lose effectiveness when Clcr < 40 ml/min Increase Na excretion by 5-
10%