Heart Failure, New (unspecified)

#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/)