How to choose treatment plan for patients with heart failure?

1. Acute heart failure

Once the diagnosis is made, treatment should be carried out according to the standard.

(1) The initial treatment was oxygen inhalation by mask or nasal catheter; Morphine, loop diuretic, cardiotonic, etc. It's all intravenous. Let the patient take a sitting position or a semi-lying position, with his legs drooping, so as to reduce venous reflux of lower limbs.

(2) Patients who are still in remission should choose vasoactive drugs according to systolic blood pressure and pulmonary congestion, such as positive inotropic drugs, vasodilators and vasoconstrictors.

(3) The condition is serious, and the blood pressure continues to drop (

(4) Dynamic determination of BNP/NT-proBNP is helpful to guide the treatment of acute heart failure. If the level after treatment is still high and the prognosis is poor, the treatment should be strengthened. After treatment, its level decreased by >: 30%, suggesting that the treatment is effective and the prognosis is good.

(5) Control and eliminate all kinds of incentives, and correct basic cardiovascular diseases in time.

2. Chronic heart failure

The treatment of chronic heart failure has changed from short-term hemodynamic/pharmacological measures such as diuresis, cardiotonic and vasodilation to long-term and restorative strategies based on neuroendocrine inhibitors, with the aim of changing the biological characteristics of failed hearts.

(1) Etiological treatment controls risk factors such as hypertension and diabetes, and antiplatelet drugs and statins are used for secondary prevention of coronary heart disease. Eliminate the inducement of heart failure, control infection, treat arrhythmia, correct anemia and electrolyte disorder.

(2) Improve symptoms and adjust the usage and dosage of diuretics, nitrates and cardiotonic agents according to the condition.

(3) The correct use of neuroendocrine inhibitors should be increased from a small dose to the target dose or the maximum dose that patients can tolerate.

(4) Monitoring the drug reaction ① If the retention of water and sodium is reduced, the dosage of diuretics can be gradually reduced or the treatment can be maintained at a small dose, and it is difficult to completely stop the drug in the early stage. Daily weight change is a reliable index to detect the effect of diuretics and adjust the dose, which can detect fluid retention early. In diuretic therapy, sodium intake should be limited (; 5.5 mmol/L) or symptomatic hypotension (systolic blood pressure

(5) Monitoring frequency Patients should self-test their weight, blood pressure and heart rate every day and register. Follow-up visit every two weeks after discharge, observe symptoms and signs, recheck blood biochemistry, and adjust drug types and doses. After the patient's condition was stable for 3 months and the drug reached the optimal dosage, he was followed up once a month.