Advanced Management

of Acute Heart Failure

dr Christine Anita SpJP FIHA
•Pharmacological
•Device therapy
Pharmacological
Evidence-based doses
of disease-modifying
drugs in key
randomized trials in
heart failure with
reduced ejection
fraction
Device therapy
• ICD (Implantable cardioverter defibrillation)
• Prevention of sudden cardiac death
• Primary  VT/VF survivor
• Secondary  LVEF <35% w/ OMT within 3 mos
• CRT (cardiac resynchronization therapy)
• QRS > 130 ms with LBBB, LVEF < 35%
• AF with high degree AV block
Comorbidities
Hypertension
Cachexia n sarcopenia
• General wasting process (sceletal muscle, fat
tissure, bone tissue
• Involuntary non-oedematous weight loss > 6% of
total body weight within 6-12 months
• Potential treatment : apetite stimulant, exercise
traingin, anabolic agents (testosterone) ,
supplements, but proven benefit and safety is
unknown
Cancer
• Certain drugs affect LV function
• Anthracyclines (doxorubicin), trastuzumab, tyrosine
kinase inhibitor
• Serial echocardiogram
Diabetes
• Metformin  first line
• Avoid : thiazolidinediones (glitaxones) and DPP4
(gliptins)  risk of worsening HF
Erectile dysfunction
• Diabetes
• Anxietas and depressive symptoms
• Drugs ( thiazide, spironolactone, beta blockers)
• Gout arthritis
• Hypo and hyperkalemia
• Anemia and ireon deficience
• Chronic kidney disease
• Lung disease (may overdiagnosed HF)
• Sleep disordered breathing  related to worse
prognosis