FROM: National Heart Foundation of Australia and Cardiac Society of Australia andNew Zealand: Guidelines for the Prevention, Detection, and Management of Heart Failure in Australia 2018 https://www.heartlungcirc.org/article/S1443-9506(18)31777-3/fulltext Pharmacological Management of Chronic Heart Failure Heart Failure With Reduced Left Ventricular Ejection Fraction (HFrEF) Medications Recommended in All Patients: Medications Recommended in…

Medications indicated Drugs used in heart failure with reduced left ventricular ejection fraction  Drug  Indications  Mechanism Adverse effects  Precautions ACE inhibitors  First-line therapy when LVEF <40%  Reduces sodium reabsorption Reduces aldosterone  Hypotension Worsening renal function HyperkalaemiaChronic cough Angioedema  Previous angioedema Other drugs that increase potassium  Angiotensin receptor antagonists (sartans)  If intolerant of ACE inhibitors  Reduces vasoconstriction Reduces…

Causes of acute decompensation of chronic heart failure Acute myocardial ischaemia or infarctionHypoxia (e.g., pneumonia, pulmonary embolism)Arrhythmia (e.g., atrial fibrillation, ventricular tachycardia/ectopy)Noncompliance with medications, fluid or salt restrictionInfection (e.g., respiratory, endocarditis, urinary, skin)Pericardial tamponadeAnaemiaReceiving drugs that may worsen chronic heart failureHyperthyroidism or hypothyroidismAdrenal insufficiency or corticosteroid excessIncreased sympathetic drive (e.g.,…

Symptoms and signs of heart failure More typical symptoms More specific signs Dyspnoea (usually with exertion)OrthopnoeaParoxysmal nocturnal dyspnoeaFatigue Elevated jugular venous pressureHepatojugular refluxThird heart soundLaterally displaced apex beat Less typical symptoms Less specific signs Nocturnal coughWheezeAbdominal bloatingAnorexiaConfusion (elderly)DepressionPalpitationsDizzinessSyncopeBendopnoea (shortness of breath when leaning forward) Weight gain (>2 kg/wk)Weight loss (in advanced…