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What is EF?
Every patient needs the actual Ejection
Fraction noted. (normal: 50%-70%)
Systolic HF: EF below 40%
Accept an EF measurement within 3-6
months, unless there has been a change
in medical events or symptoms.
example
64 y/o man with ischemic CM, baseline EF
25%, normally NYHA Class II, who
presented in pulmonary edema (Class IV).
In retrospect, he acknowledged more
shortness of breath for the last two weeks.
The night before coming to the hospital, he
slept in the chair.
HF Medications
ALL CARDIOVASCULAR patients:
aspirin (or warfarin; Plavix if stent)
beta blocker
ACE inhibitor or Angiotensin Receptor
Blocker (ARB)
cholesterol management if ischemic
aldosterone inhibitor
Medications, cont
Beta Blockers SAVE lives!!!
Medications: AA
AA HF Study:
Hydralazine and Isosorbide added to ACEI
and BB, maximal medical therapy
Survival benefit
Note dosing: both are TID and isosorbide is
the dinitrate (isordil), not mononitrate (Imdur)
Target: hydralazine 75 mg TID
Target: isosorbide 40 mg TID
Education
Cardiac Rehab can help needs a consult request. (MF). You will need to educate on weekends and holidays.
Become familiar with educational materials, resources.
Please record in chart, teach patient and reiterate at
discharge:
salt restriction
A few comments
Reason for decompensation:
A few comments #2
Ascertain barriers to care:
A few comments #3
Ascertain what is this patients normal
blood pressure.
If EF is poor, BP will be below 100mmHg.
Do NOT hold/stop cardiac medications!!!
rebound HF, death, MI etc. etc.
Write orders so nurses give meds.
Discharge Process
EF documented
Medications prescribed, or documented
why not : 1) BB, 2)ACE/ARB
ICD addressed
Education completed
Follow-up arranged
Dictated. (Please include consultants
names, rather than cardiology saw pt.)