Congestive Heart Failure
Evaluation
General—clinical syndrome which affects heart function; that is, the ability to fill and/or pump blood
Clinical—dyspnea, fatigue, edema (lungs and legs); + jugular venous pressure (JVP), gallop (S3), and crackles
Laboratory findings—increase in brain natriuretic peptide (BNP)
Classification
New York Heart Association (NYHA) Functional Classification of Heart Failure (see Table 2.16.1)
American College of Cardiology/American Heart Association Stages of Heart Failure (see Table 2.16.2)
Common heart failure medications
ACE-inhibitors—improve survival, decrease rate of hospitalization, decrease symptoms, and reverse remodeling.
CAUTION—watch for hyperkalemia, angioedema, and cough
Angiotensin-receptor blockers (ARBs)—to be used only in those who cannot tolerate ACE-inhibitors.
CAUTION—watch for hyperkalemia and angioedema
β-Blockers—counteracts harmful effects of sympathetic nervous system, improve survival, and decreases remodeling.
Loop diuretics—used to control symptoms of congestion.
CAUTION—hypokalemia; ototoxicity at higher doses
Digoxin—no mortality benefit, but decrease worsening heart failure and hospitalization
