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MANAGEMENT OF CONGESTIVE HEART FAILURE

MANAGEMENT OF CONGESTIVE HEART FAILUREEzekiel T. Arteta, m.d.Ospital ng maynila medical centerADMITTING ORDERSDiet: Low salt, low fat diet with SAPDiagnostics: CXR, CBC with PC, BUN, Creatinine, SGPT, SGOT, KUB UTZ, Ca, Mg, Alb, Na, K, Cl, UA, Troponin I quantitative, 12 L ECG, CBG, FBS, Lipid profile, 2D echo with DS, PBSMedications:1) ASA 80g/tab OD after lunch2) Ketosteril 1 capsule3) Clopidogrel 75mg/tab 1 tab OD after lunch4) Amlodipine 10mg/tab, 1 tab OD in the am5) Atorvastatin 40mg/tab, 1 tab ODHS6) Lactulose 30cc ODHS7) Clonidine 75mg/tab 1 tab Sl PRN BP>160/1008) Furosemide 40mg/tab BID9) ISDN 5mg/tab as needed for chest pain10) Ceftriaxone 2g TIV OD ANST11) Azithromycin 500mg/tab 1 tab OD12) NAC 600mg/tab 1 tab mixed in 100cc water ODSTAGE AHigh risk for developing HFDo not have structural heart disease or symptoms of HFSTAGE BHave structural heart diseaseDo not have symptomsSTAGE CHave structural heart diseaseHave developed symptoms of HFSTAGE DRefractory HFDEFINING AN APPROPRIATE THERAPEUTIC STRATEGY FOR CHRONIC HFOnce patients have developed structural heart disease, their therapy depends on their NYHA functional classification.Slow disease progression by blocking neurohormonal systems in Class I patientsAlleviate fluid retention, lessen disability and reduce the risk of further disease progression and death in Class II to IV patientsFor patients who have developed LV systolic dysfunction but remain asymptomatic (CLASS I), slow disease progression by blocking neurohormonal systems that lead to cardiac remodeling

4MANAGEMENT OF HF WITH DEPRESSED EJECTION FRACTION (