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Heart Failure: Difference between revisions
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==Pharmacological treatment== | ==Pharmacological treatment== | ||
A flowchart for treatment of patients presenting with systolic HF is depicted in Figure 5. Medication with a class I indication in patients with systolic heart failure are summarized in Table 5. Indications, mode of action, contraindications of the medication, and possible side effects included in this algorithm are discussed below. | |||
[[Image:Image1.jpg|thumb|Figure 5 treatment options for patients with chronic systolic HF]] | [[Image:Image1.jpg|thumb|Figure 5 treatment options for patients with chronic systolic HF]] | ||
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|bgcolor=" | |bgcolor="1E90FF" align="center"|'''NYHA I & EF <40%''' | ||
|bgcolor=" | |bgcolor="1E90FF" align="center"|'''NYHA II''' | ||
|bgcolor=" | |bgcolor="1E90FF" align="center"|'''NYHA III''' | ||
|bgcolor=" | |bgcolor="1E90FF" align="center"|'''NYHA IV''' | ||
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|bgcolor="99FFCC"|'''Diuretic''' | |bgcolor="99FFCC" align="center"|'''Diuretic''' | ||
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|bgcolor="99FFCC"|'''ACE-inhib''' | |bgcolor="99FFCC" align="center"|'''ACE-inhib''' | ||
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|bgcolor="99FFCC"|'''AT-II antagonist''' | |bgcolor="99FFCC" align="center"|'''AT-II antagonist''' | ||
|bgcolor="99FFCC"| | |bgcolor="99FFCC"| | ||
|bgcolor=" | |bgcolor="9ACD32" align="center"|'''Alternative''' | ||
|bgcolor=" | |bgcolor="9ACD32" align="center"|'''Alternative''' | ||
|bgcolor=" | |bgcolor="9ACD32" align="center"|'''Alternative''' | ||
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|bgcolor="99FFCC"|'''Betablocker''' | |bgcolor="99FFCC" align="center"|'''Betablocker''' | ||
|bgcolor=" | |bgcolor="9ACD32" align="center"|'''Post infarction''' | ||
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|bgcolor="99FFCC"|'''Aldosteron antagonist''' | |bgcolor="99FFCC" align="center"|'''Aldosteron antagonist''' | ||
|bgcolor="99FFCC"| | |bgcolor="99FFCC"| | ||
|bgcolor=" | |bgcolor="9ACD32" align="center"|'''EF = 35%''' | ||
|bgcolor=" | |bgcolor="9ACD32" align="center"|'''EF = 35%''' | ||
|bgcolor=" | |bgcolor="9ACD32" align="center"|'''EF = 35%''' | ||
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|bgcolor="99FFCC"|'''Nitrate / Hydralazine''' | |bgcolor="99FFCC" align="center"|'''Nitrate / Hydralazine''' | ||
|bgcolor="99FFCC"| | |bgcolor="99FFCC"| | ||
|bgcolor=" | |bgcolor="9ACD32" align="center"|'''Afro-American''' | ||
|bgcolor=" | |bgcolor="9ACD32" align="center"|'''Afro-American''' | ||
|bgcolor=" | |bgcolor="9ACD32" align="center"|'''Afro-American''' | ||
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|bgcolor="99FFCC"|'''Digoxin''' | |bgcolor="99FFCC" align="center"|'''Digoxin''' | ||
|bgcolor="99FFCC"| | |bgcolor="99FFCC"| | ||
|bgcolor="99FFCC"| | |bgcolor="99FFCC"| | ||
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|colspan="5"|Table 5 Medication with a class I indication in patients with systolic heart failure. Note that AT-II antagonists are alternative medicine for ACE inhibitors in case of intolerance (coughing, allergy). Nitrates and Hydralazine are added therapy for patients of Afro-American descent, and alternative therapy for patients that cannot tolerate ACE-inhibitors and AT-II antagonists). Digoxin can also be seen as symptomatic (instead of added preventive) treatment, not always necessary in NYHA III or even IV. | |colspan="5"|Table 5 Medication with a class I indication in patients with systolic heart failure. Note that AT-II antagonists are alternative medicine for ACE inhibitors in case of intolerance (coughing, allergy). Nitrates and Hydralazine are added therapy for patients of Afro-American descent, and alternative therapy for patients that cannot tolerate ACE-inhibitors and AT-II antagonists). Digoxin can also be seen as symptomatic (instead of added preventive) treatment, not always necessary in NYHA III or even IV. | ||