Key Concepts

O The most common causes of heart failure are coronary artery disease (CAD), hypertension, and dilated cardiomyopathy.

^^ Development and progression of heart failure involve activation of neurohormonal pathways, including the sympathetic nervous system (SNS) and the renin-angiotensin-aldosterone system (RAAS).

The clinician must identify potential reversible causes of heart failure exacerbations including prescription and nonprescription drug therapies, dietary indiscretions, and medication nonadherence.

^^ Symptoms of left-sided heart failure include dyspnea, orthopnea, and paroxysmal nocturnal dyspnea (PND), whereas symptoms of right-sided heart failure include fluid retention, GI bloating, and fatigue.

Therapeutic goals focus on alleviating symptoms, slowing or preventing disease progression, maintaining quality of life, and improving patient survival.

® Nonpharmacologic treatment involves dietary modifications such as sodium and fluid restriction, risk factor reduction including smoking cessation, timely immunizations, and supervised regular physical activity.

^^ Diuretics are used for relief of acute symptoms of congestion and maintenance of euvolemia.

® Agents with proven benefits in improving symptoms, slowing disease progression, and improving survival in chronic heart failure target neurohormonal blockade; these include angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), P-adrenergic blockers, and aldosterone antagonists.

O Combination therapy with hydralazine and isosorbide dinitrate is an appropriate substitute for angiotensin II antagonism in those unable to tolerate an ACE inhibitor or ARB, or as add-on therapy in African Americans.

© Treatment of acute heart failure (AHF) targets relief of congestion and optimization of cardiac output utilizing oral or IV diuretics, IV vasodilators, and, when appropriate, inotropes.

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