> For the complete documentation index, see [llms.txt](https://thisispiggy.gitbook.io/my-wiki/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://thisispiggy.gitbook.io/my-wiki/01-step-1/cardiology/28-chronic-hf.md).

# 28 Chronic HF

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/chronic%20HF%20types%20and%20overall%20treatment/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/Kk7XMyU.jpg)

* systolic: drugs improve mortality
* diastolic: no specific therapy, no real treatment

![](https://f001.backblazeb2.com/file/wikiFiles/JyxaRB8.jpg)

## Systolic

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Cardiology/systolic%20chronic%20HF%20treatment/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/jboo6g6.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/sBC4E7L.jpg)

* all the results bad for a weak heart (chronic systolic HF)

![](https://f001.backblazeb2.com/file/wikiFiles/jCmI23p.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/CmdUp2h.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/zsfSDU8.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/E38KJVR.jpg)

* good for chronic not acute

![](https://f001.backblazeb2.com/file/wikiFiles/w1m8WZc.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/H0Yoq4n.jpg)

* A-BEAM spotlight on heart: the beta-1 selective antagonists primarily suppress adrenergic stimulation of the heart (cardioselective)
* Broken heart strings under A-BEAM spotlight: cardioselective beta blockers are useful in the acute treatment of MI and other acute coronary syndromes (ACS)
* Failing heart balloon in the A-BEAM spotlight: cardioselective beta blockers are useful in the management of chronic heart failure
* Extinguished alpha candle on CARVED candleholder: carvedilol is a nonselective beta blocker and alpha-1 blocker
* CARVED candleholder next to failing heart: carvedilol (in addition to cardioselective beta blockers) is useful in the management of chronic heart failure.
* Angel: beta blockers (e.g. carvedilol and cardioselective agents) reduce mortality in chronic heart failure and post-MI
* Remodeling: beta blockers reduce cardiac remodeling by protecting the heart from excess circulating catecholamines

![](https://f001.backblazeb2.com/file/wikiFiles/Rv9CpTP.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/DXiEsdc.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/e65ouNz.jpg)

* Failing heart balloon: K+ diuretics (e.g. spironolactone, eplerenone) are useful in the treatment of heart failure
* Remodeling: mineralocorticoid antagonists (e.g. spironolactone, eplerenone) prevent myocardial remodeling induced by high levels of aldosterone
* Angel: mineralocorticoid antagonists (e.g. spironolactone, eplerenone) decrease mortality in heart fail
* Lids on chest: spironolactone can cause gynecomastia
* Droopy churro: spironolactone can cause impotence and decreased libido

![](https://f001.backblazeb2.com/file/wikiFiles/FPdPfqh.jpg)

* eplerenone better for men

![](https://f001.backblazeb2.com/file/wikiFiles/9MdmXeB.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/mQK5jjI.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/tRk4Zwl.jpg)

* feared SE: angioedema

![](https://f001.backblazeb2.com/file/wikiFiles/krk5D15.jpg)

* higher HR: heart work harder
* for pts on max dose BB

![](https://f001.backblazeb2.com/file/wikiFiles/8DccDwv.jpg)

* low EF: high annual risk of SCD

![](https://f001.backblazeb2.com/file/wikiFiles/Xuhy6IJ.jpg)

* monitors heart rhythm, shocks heart when detect dangerous rhythm

![](https://f001.backblazeb2.com/file/wikiFiles/uEwDYzm.jpg)

* left: LV and RV asynchronized contraction, BBB
* very different from slow heart pacemaker