Clinical HF syndrome with LVEF ≤40%.
Causes
- • Ischaemic heart disease
- • HTN
- • Dilated CMO
- • Valvular disease
- • Toxin (alcohol, chemo)
- • Peripartum, tachy-CMO
Clinical features
- • Dyspnoea, orthopnoea, PND, fatigue, oedema
Investigations
- • BNP/NT-proBNP
- • ECG, echo (EF, wall motion)
- • Cardiac MRI if aetiology unclear
- • Coronary angiography
Management
- • Four pillars: ARNI (or ACEi/ARB) + β-blocker + MRA + SGLT2i (dapagliflozin/empagliflozin)
- • Loop diuretic for congestion
- • Ivabradine if HR ≥75 on max β-blocker
- • Hydralazine + isosorbide dinitrate if intolerant to ARNI (esp black patients)
Drug therapy
- • ARNI: sacubitril/valsartan 24/26–97/103 mg BD
- • Bisoprolol/carvedilol/metoprolol XL up-titrated
- • Spironolactone/eplerenone 12.5–50 mg OD
Complications
- • Arrhythmia (SCD)
- • HF hospitalisations
- • Cardiorenal syndrome
Prevention
- • Cardiac rehab
- • Vaccination (flu, pneumococcal)
- • Salt/fluid restriction
Follow-up
- • Uptitrate in 2-week intervals
- • 6-week review post-discharge
Clinical pearls
- • Start all four pillars early even at low doses
- • Advanced HF referral if refractory (transplant, LVAD)
References
- • ESC 2021 HF + 2023 focused update
- • AHA/ACC 2022 HF
Related in WardRound
Educational — verify locally.
