Patient Encounter Part 3

Based on the information presented and your problem-based assessment, create a care plan for BE's HF. Your plan should include:

Nonpharmacologic treatment options.

Acute and chronic treatment plans to address BE's symptoms and prevent disease deterioration.

Monitoring plan for acute and chronic treatments.

Unlike systolic HF, few prospective trials have evaluated the safety and efficacy of various cardiac medications in patients with diastolic HF or preserved EF. The Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM) study demonstrated that angiotensin receptor blockade with candesartan resulted in beneficial effects on HF morbidity in patients with preserved LVEF similar to those seen in depressed LV function.

In the absence of more landmark clinical studies, the current treatment approach for diastolic dysfunction or preserved LVEF is: (a) correction or control of underlying etiologies (including optimal treatment of hypertension and CAD and maintenance of normal sinus rhythm); (b) reduction of cardiac filling pressures at rest and during exertion; and (c) increased diastolic filling time. Diuretics are frequently used to control congestion. Recent studies failed to show significant reductions in mortality or hospitalizations with use of ARBs. P-Blockers and calcium channel blockers can theoretically improve ventricular relaxation through negative inotropic and chronotropic effects. Unlike in systolic HF, nondihydropyridine calcium channel blockers (diltiazem and verapamil) may be especially useful in improving diastolic function by limiting the availability of calcium that mediates contractility. A recent study did not find favorable effects with digoxin in patients with mild to moderate diastolic HF. Therefore, the role of digoxin for symptom management and HR control in these patients is not well established.

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