# 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 ***.
- 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
- 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:
-Non-ischemic evaluation. First pass: EtOH/drug hx, TSH, HIV, +/- SPEP/UPEP. 2nd Pass V/Q scan, Cardiac MRI, PET.
-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
-Indicated for cardiogenic shock or failure to make urine with very high dose diuretic.
-Aldo: (EF < 30%, NYHF III).
-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.
-Consider empagliflozin (Jardiance) if eGFR > 45 and A1C > 7 despite metformin
-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.
-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/)