Cardiology
Heart Failure & Cardiomyopathies
Cardiology

Heart Failure & Cardiomyopathies

HFrEF mortality drugs, HFpEF, cor pulmonale, restrictive, HOCM.

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◆HFrEF drugs WITH mortality benefit

  • •ACEi/ARB or ARNI (sacubitril/valsartan)
  • •Beta-blockers: carvedilol, metoprolol succinate, bisoprolol ONLY
  • •Aldosterone antagonists (spironolactone, eplerenone)
  • •SGLT2 inhibitors (dapagliflozin, empagliflozin)
  • •Hydralazine/nitrates (esp. in Black patients)

◆HFrEF drugs WITHOUT mortality benefit

  • •Digoxin: symptom relief only
  • •Diuretics: symptom relief only

◆HFpEF / Cor pulmonale

  • •Right-sided HF signs: JVD, hepatomegaly, peripheral edema (clear lungs)
  • •Causes: COPD, ILD, OSA, CTEPH, connective tissue diseases (systemic sclerosis)
  • •Loud P2 + RV strain on echo → pulmonary HTN
  • •Right heart cath to confirm PA pressures (PCWP ≤15 = arterial; >15 = left-heart cause)

◆Cardiomyopathies

  • •Viral myocarditis (Coxsackie B) → dilated CM in young + viral prodrome + ↓EF + biventricular dilation
  • •Trastuzumab → reversible cardiomyopathy (S3 gallop); anthracyclines (doxorubicin) → IRREVERSIBLE (dexrazoxane reduces)
  • •Restrictive: preserved EF + low-voltage QRS + radiation/amyloid/sarcoid/hemochromatosis
  • •HOCM: young + systolic murmur LOUDER with Valsalva; AVOID competitive athletics

◆HOCM management

  • •Asymptomatic: activity restriction; ICD if high-risk (prior VT/VF, FHx SCD, syncope, septum >30 mm)
  • •Symptomatic: beta-blocker first; verapamil if BB contraindicated
  • •Refractory: surgical myectomy or alcohol septal ablation
  • •Most common cause of death in HOCM: VF
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