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    Heart Failure, New (unspecified)

    CHF

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    Assessment & Plan (short)

    # Heart Failure, New (unspecified)
    Patient presents with new symptoms of heart failure and evidence of volume overload. Suspect secondary to ***. Common etiologies include ischemic, infiltrative, structural, endocrine, viral, toxin-mediated, tachycardia, and idiopathic.
    Admission weight ***, dry weight ***.
    Dx
    - Bedside TTE showing ***
    - Bedside IVC showing ***
    - BMP, Mg, CBC, troponin, BNP
    - CXR, EKG
    - HgbA1C, Lipid panel
    - TSH, HIV, Ferritin, Utox, UA
    - Formal TTE, telemetry
    - Consider left heart cath
    - Strict I/O, daily standing weights
    Tx
    - Goal net negative: ***
    - Preload: ***
    - Afterload: ***
    - Neurohormonal blockade: ***
    - Na-restricted diet (<3 grams per day), 2L fluid restriction
    - Replete K>4, Mg>2

    Assessment & Plan (long)

    #Systolic Heart Failure:
    Etiology:
    -Coronary evaluation.
    -Non-ischemic evaluation. First pass: EtOH/drug hx, TSH, HIV, +/- SPEP/UPEP. 2nd Pass V/Q scan, Cardiac MRI, PET.
    Volume:
    -Estimated Dry Weight =
    -Goal net neg ***L/day
    -Spot dose Lasix *** IV q6 hours to meet above goal.
    -Keep K>4, Mg>2
    -Daily Standing weights
    -Strict I/O
    Inotropic Support:
    -Indicated for cardiogenic shock or failure to make urine with very high dose diuretic.
    Hormonal Blockade:
    -ACE/ARB:
    -BB:
    -Aldo: (EF < 30%, NYHF III).
    -Further Afterload:
    -Advanced meds:
    -Valsartan/sacubitril (Entrusto) instead of ACE/ARB, no ACE/ARB x 48 hours, eGFR >30, ?dementia?
    -Ivabradine (Corlanor): If on goal dose bblocker, NSR only, & HR > 70.
    DM:
    -Consider empagliflozin (Jardiance) if eGFR > 45 and A1C > 7 despite metformin
    Devices:
    -AICD: Secondary prevention, Primary prevention (Ischemic EF<40%, non-ischemic EF<35%, both s/p optimal medical Rx x 3 months)
    -CRT: EF < 30% and QRS > 120.
    Follow up:
    -Ensure f/u with PCP or cardiology within 10 days of DC
    -Ensure pt has scale at home and can weigh self daily. If pt gains > 3lbs in 24 hours or >5lbs in 7 days, pt is to double diuretic dose x1 and call MD.
    -Torsemide (and bumex) PO preferred over lasix for reduction in HF hospitalizations and CV mortality (https://pubmed.ncbi.nlm.nih.gov/30846351/)

    Organ systems
    • Cardiovascular
    Medical field
    • Internal medicine
    Setting
    • Inpatient
    Related dotphrases
    Heart Failure (HFpEF) exacerbation
    Heart Failure (HFrEF) exacerbation
    Author
    Eric Lee
    Page info

    Originally created: March 3, 2020 by Eric Lee

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    Number of revisions: [xyz-ips snippet="numrevisions"]

    References
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