Heart failure with Reduced Ejection Fraction (HFrEF)
1. Typical symptoms: dyspnea, orthopnea paroxysmal noctumal dyspnea, fatigue, reduced exercise tolerance, and ankle swelling.
2. Less Typical Symptoms: cough, abdominal distension, wheeze, abdominal bloating, and early satiety, bendopnea.
3. More Specific Signs: elevated jugular venous pressure, positive abdominojugular, reflux s3 (gallop rhythm), and laterally displaced apical impulse.
4. Less Specific Signs: weight gain, lung rales, peripheral edema, ascites, cool and/or mottled extremities, narrow proportional pulse pressure (pulse pressure: systolic blood pressure ratio 0.25), murmur of valvular regurgitation or stenosis, weight loss and cachexia (advanced heart failure).
*Chronic HFrEF may lack lung rales, peripheral edema compensatory upregulation un lymphatic
1. Chest x-ray: signs of congestion (Sens. 81% for acute HF), cardiomegaly (S 64-79%), 95% specificity or >: (peribronchial cuffing, Kerley B lines, alveolar edema, bilateral pleural effusions). 1/5 pts w/ acute HF → no signs of CXR congestion.
2. Transthoracic echocardiography: identifies systolic dysfunction
3. Coronary angiography (or coronary computed tomography angiography if low pretest probability): identificaton of obstructive epicardial coronary artery disease
4. Consider cardiac magnetic resonance imaging, positron emission tomography scan, or 99m technetium pyrophosphate scan.
Other: Electrocardiogram, Consider right heart catheterization, consider endomyocardial biopsy
• ACE Inhibitors and ARBs
• ARNIs (Angiotensin receptor-neprilysin inhibitors)
• MRAs (Mineralocorticoid receptor antagonists)
• Hydralazine / Isosorbide Dinitrate
- Dr. Jorge Cortés @Jcortesizaguirr
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