A combination of drug types is recommended in the routine management of patients with HF. For patients with HF with reduced ejection fraction, a combination of ACEI/ARB/ARNI, beta-blocker, mineralocorticoid antagonist, and an SGLT2 inhibitor is recommended by the latest guidelines. For patients with HF with preserved ejection fraction, an SGLT2 inhibitor is indicated, and consideration should be given for ARNI and a mineralocorticoid antagonist. Diuretic therapy is also often needed to manage excess volume that can accumulate in patients.
Nitrates are potent venodilators. These agents decrease preload and therefore decrease LV filling pressure and relieve dyspnea. They also selectively produce epicardial coronary artery vasodilatation and help with myocardial ischemia. Nitrates can be used in different forms (sublingual, oral, transdermal, intravenous). Use of nitrates is limited by tachyphylaxis and headache.
Patients with HF can benefit from attention to exercise, diet, and nutrition. Restriction of activity promotes physical deconditioning, so physical activity should be encouraged. However, limitation of activity is appropriate during acute HF exacerbations and in patients with suspected myocarditis. Most patients should not participate in heavy labor or exhaustive sports.
For additional information, refer to the following clinical practice guidelines:
2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
2021 European Society of Cardiology (ESC) Acute and Chronic Heart Failure Guidelines
Learn more about the treatment of HF.
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Cite this: Yasmine S. Ali, Jeffrey J. Hsu. Fast Five Quiz: Test Your Knowledge on Key Aspects of Heart Failure - Medscape - Dec 19, 2022.