Of the available agents for treating shock, dopamine remains unusually popular. Although the drug’s varying effects at different doses are thought to afford it several advantages compared to other vasoactive agents, in this post I’ll share three reasons why you should consider replacing dopamine in your practice.
Lessons Learned in the Management of Heart Failure GDMT (Part 1): Beta-Blockers in Acute Decompensated Heart Failure
In patients with heart failure, guideline-directed medical therapy is often mismanaged during acute decompensation, particularly with regard to beta-blocker therapy. In this entry, we discuss how to manage beta-blockers in patients with acute decompensated heart failure.
Getting to the Heart of the Patient Interview: A Focus on Heart Failure (Part II)
A thorough and accurate patient assessment is critical to managing patients with heart failure. In this second post of our two-part series, we’ll focus on volume status and adherence to medications and dietary recommendations. Check out our first post for general principles and an assessment of functional status. A template collection tool is also provided.
Getting to the Heart of the Patient Interview: A Focus on Heart Failure (Part I)
A thorough and accurate patient assessment is critical to managing patients with heart failure. In this two-part series, we’ll provide an overview of the key components of assessing patients with heart failure, starting first with general principles and an evaluation of functional status. Our second piece will focus on volume status and adherence to medications and dietary recommendations. A template collection tool is also provided.
Titration of Renin-Angiotensin System Inhibitors in Patients with Heart Failure with Reduced Ejection Fraction and an “At-Goal” Blood Pressure
Initiation and titration of guideline-directed medical therapy is paramount for patients with heart failure with reduced ejection fraction (HFrEF), as it reduces the risk of death and other complications. Despite this, many patients do not receive the appropriate therapies or doses due to concerns and/or misconceptions about the use of these therapies. One reason often cited for not using or titrating inhibitors of the renin-angiotensin system is that blood pressure is already “at goal” or is “too low”. In this blog, the data surrounding titration of angiotensin converting enzyme inhibitors, angiotensin II receptor blockers and the angiotensin II receptor blocker/neprilysin inhibitor in patients with HFrEF will be addressed.
Cocaine and Beta Blockers: All It’s Cracked Up to Be?
Beta blockers remain a cornerstone in the management of several cardiovascular disorders yet many clinicians are reluctant to use them in the setting of cocaine abuse. In this entry, we take a look at the evidence.
Muddying the Water: Reduced vs. Preserved Ejection Fraction in Trials of Acute Decompensated Heart Failure
Evidence from randomized controlled trials has demonstrated that the cornerstone pharmacologic therapies used in the management of chronic heart failure with reduced ejection fraction (HFrEF) do not confer the same benefits in patients with preserved ejection fraction (HFpEF). So why do we enroll both subgroups in trials of acute decompensated heart failure (ADHF)? In this entry, we’ll explore differences in pathophysiology between HFrEF and HFpEF and how they may result in variable responses to pharmacologic therapies commonly used in ADHF, particularly diuretics and vasodilators.
Novel Potassium-Lowering Agents in Combination with Chronic Heart Failure Therapies
Agents such as patiromer and sodium zirconium cyclosilicate can reduce serum potassium concentrations. But do they have a role in patients with heart failure with reduced ejection fraction (HFrEF)? In this piece, we explore whether these agents could reduce the risk of hyperkalemia when initiating, continuing, or dose-titrating guideline-directed medical therapies in HFrEF.
Mineralocorticoid Receptor Antagonists: The Cardiovascular Wonder Class (Part 2)
In Part 1 of this two-part series, we dissected the evidence behind the use of MRAs in HFrEF, HFpEF and MI to further understand the reasons for their underutilization and alleviate some of those concerns. In Part 2, the use of MRAs in resistant hypertension will be discussed, as well as considerations regarding blood pressure, potassium, and renal effects given these may play key roles in precluding MRA use when warranted.
Mineralocorticoid Receptor Antagonists: The Cardiovascular Wonder Class (Part I)
Mineralocorticoid receptor antagonists are arguably one of the most underutilized medication classes despite sound evidence supporting their use across a spectrum of cardiovascular diseases. Part 1 of this two-part series chronicles current evidence evaluating the use of MRAs, particularly spironolactone, in the treatment of heart failure (both chronic and acute settings) and myocardial infarction.