Epidemiology
40% to 50% of patients hospitalized
have HFpEF.
disproportionally affects elderly
people, with a mean age of 75 years
affects men and women almost
equally,
Hypertension is the most prevalent
of the concurrent conditions
Pathophysiology
Goals of Management
1. Stabilize hemodynamic derangements
2. Identify and treat reversible
precipitating factors
3. Prevent disease progression and relapse
Pharmacotherapy of Acute HF
VASODILATORS
Nitroglycerin
Nitroprusside
Nesiritide
Pharmacotherapy of Acute HF
INOTROPES
Dobutamine
Milrinone
Levosimendan
Pharmacotherapy of Acute HF
VASOCONSTRICTORS
Dopamine
Epinephrine
Phenylephrine
Vasopressin
Support systemic BP
LVAD
Anti-arrhthymic
drugs
Indications
Comments
Atrial fibrillation
Warfarin preferred, or
Any embolic event,
heparin for bed-bound pxs
regardless of
Aspirin is a reasonable
rhythm
alternative if full antiImmobilization in
coagulation is contrabed
indicated for other reasons
Atrial fibrillation
Digoxin effectively controls
the ventricular rate in AF
Indications
Ventricular
tachycardia
Other antiarrhythmic
Amiodarone is also
usually DOC
Life threatening
arrhythmias not resp
to drugs
Surgical ablation,
ICD