Transcript Summary of TP Chua's Heart Failure Talk in Cologne

Direct Access Echo RSCH
Indication:
Suspected Heart Failure
With abnormal ECG or
Intermediate BNP (100-400)
BNP:
Asymptomatic Murmur
Asymptomatic
Cardiomegaly On CXR
Direct Access Echo RSCH
Footnote:
Please do not use open access
Echo but refer directly to
consultant for:
1. Pts with symptoms and
signs of CHF or very high
BNP
2. Pts with symtomatic heart
murmurs
3. Known heart failure with
previous echo
4. Other cardiac problems
Drug therapy in CHF
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Diuretics
ACE inhibitors
B - blockers
Spironolactone (Class III & IV patients)
Angiotensin II receptor blockers
(Alternative to ACE I)
Hydralazine & ISDN (ACE I/ARB
intolerance or in renal failure or in AfroCarribeans as in the AHeFT trial)
Digoxin if still symptomatic or in AF
Dose of ACE Inhibitors in CHF
Initial Dose*
Optimal Dose
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Enalapril
2.5 mg od
10-20 mg bd
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Lisinopril
2.5 mg od
20-40 mg od
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Perindopril 2 mg od
4 mg od
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Ramipril
10 mg od
1.25-2.5 mg od
* If there are signs of dehydration, stop diuretics for 24 hrs
before initial dose of ACE inhibitor
Summary of Drug Treatment of CHF
CHF Confirmed
ACE Inhibitors (or ARBs)
Oedema
Diuretics + Consider
Spironolactone in Class III/IV pts
AF
Digoxin + Warfarin
No congestion
Beta-blockers
Angina
ISMN / Amlodipine
Conclusions
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BNP will help exclude heart failure
ECG also useful in excluding CHF - can use
this for triage
Intermediate BNP levels can be found in
CHF/IHD/ACS, treated CHF with noncardiac cause of dyspnoea or non-CHF with
non-cardiac cause of dyspnoea including PE
and pneumonia
Echocardiography for definitive diagnosis
BNP and open access echocardiography now
available for primary care in Guildford