Congestive Heart Failure
Signs and Symptoms
Left sided heart failure: dyspnea on exertion, orthopenia, tachypnea, cough, rales, pulmonary edema, pleural effusion, S3 gallops
Right sided heart failure: abdominal pain, nausea, anorexia, bloating, ascites, peripheral edema, hepatojugular reflux
Classification of Congestive Heart Failure (NYHA)
Class Presentation
Class I symptoms only on strenuous exertion
Class II asymptomatic on rest, symptomatic with normal activity
Class III asymptomatic on rest, very symptomatic with minimal activity
Class IV symptomatic at rest, increases with activity
Treatment Guidelines (Systolic Congestive Heart Failure)
Place on a sodium restricted diet (2000-3000mg/day)
Start on loop diuretics (ex. Furosemide) to decrease fluid overload.  Monitor electrolytes and renal function.
Can add metolazone to help reduce resistance to loop diuretic
ACE inhibitor therapy should be initiated in all patients with CHF, unless contraindicated
Angiotension receptor blockers can be employed where ACE inhibitors are not tolerated
Beta-blockers can be used in NYHA class II or III heart failure
Digoxin is indicated in patients with CHF and atrial fibrillation (help improve quality of life)
Hydralazine +/- isosorbide dinitrate can be used where ACE inhibitors are contraindicated
Spironolactone has been shown to improve symptoms in patients with NYHA class III or IV congestive heart failure
Anticoagulation is only recommended for patients who had recent atrial fibrillation, recent pulmonary embolism, recent systemic embolism, or mobile left ventricular thrombi
Treatment Guidelines (Diastolic Congestive Heart Failure)
Treat the underlying cause of the diastolic heart failure
Use nitrates and/or diuretics in symptomatic patients (avoid over-diuresis - may lead to hypotension)
Beta-blockers or calcium channel blockers are useful in allowing ventricles more time to fill
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